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Forget Memory – it’s about relationships

Forget Memory – it’s about relationships

Like most of you, we have attended a lot of conferences, workshops and seminars since entering the “Senior Living” sector. As repeat attendees of The Annual Memory Care Summit and representing a graduate of The Erickson School, we have one single expectation from the UMBC Aging brand and team – delivery of academic and person-centered content that can “excite and delight” business as usual. We use that phrase intentionally because our own team has just finished a group read (on Audible – our go to “employee training” app) of Joseph Coughlin’sLongevity Economy.” Coughlin, introduces – among several other things – the concept of “transcendent” design where we focus on developing consumer products that will excite and delight all ages and not seniors alone. He encourages all of us to embrace what we would consider a “strengths-based” approach – where we design products for ability and inclusive opportunity rather than trying to solve problems that only highlight deficits in the targeted end-user. This kind of thinking should apply equally to our planned communities and programming.

“Our heritage and ideals, our code and standards – the things we live by and teach our children – are preserved or diminished by how freely we exchange ideas and feelings”   

Walt Disney

American entrepreneur, The Walt Disney Company

We are entering (or perhaps returning to) a new chapter in our Industry and culture where the curse of knowledge (in business and clinically) is being replaced by an emphasis on the fundamentals of imagination and relationship-building. What kind of future would we imagine, and then build, if we focused more exclusively on engaging across generations and sharing stories, experience and knowledge to that universal end?

Imagination vs  Experience

If last year was about creating magical moments, and fine tuning company culture for sustained results, this year offered the charge to advance our Iconoclast Quotient (IQ) in recognition that while “Logic will take you from A to B, Imagination will take you anywhere.” Ideas and Interests are converging at an accelerated pace. If we want to offer health and wellness services to family, staff and residents, we will be required to meet our customers (all of them) wherever they are – and it will take the whole village to support their wants and needs effectively. In the past we have relied upon experience to light our path. In the immediate future we all need to be trailblazers of some degree.

Heroism and Incrementalism

In typical Erickson School fashion (this is the academic influence) a series of “pre-reading” materials were circulated via Dropbox to attendees  – among these was a link from Bob  Kramer of NIC to a recent New Yorker piece entitled “ The Heroism of Incremental Care” In the article, Atul Gawande shares an interesting metaphor surrounding the collapse of the Silver Bridge in 1967:

“The collapse signaled the need for a new strategy. Although much of the United States’ highway system was still relatively new, hundreds of bridges were more than forty years old and had been designed, like the Silver Bridge, for Model T traffic. Our system was entering middle age, and we didn’t have a plan for it.”

In this essay, emphasis was tied largely to the dichotomy of surgeons (heroes) and primary care physicians (incrementalists). For our purposes here, the relationship between outdated transportation infrastructure and our own bricks and mortar in Senior Living is key. We all know that we are developing products that are designed around realities/constraints and beliefs that are no longer relevant – like the Model T – and yet we still charge on without reconsidering the viability of our footings. It is worth emphasizing that EVERY time a guest speaker has joined the stage (we have been to four of the six events) they are emphatic about not wanting our “products or services.” We clearly need visionaries and iconoclasts to chart new courses for our Industry where we focus on engagement instead of behavior management alone.

5 Leadership Lessons from The Disney Institute

As leaders in the “Imagination” department,  Mark Matheis offered the Disney Company’s’ perspective on how best to execute your plans once imagined:

  1. Leaders establish, operationalize, and sustain the values and vision by which their organizations  thrive.
  2. Great leaders proactively establish values.
  3. The more a vision can be expressed in a vivid, imaginative way, the more it will motivate people to action in the present.
  4. Storytelling is an essential strategy for the communication of new ideas; people are more engaged and inspired by information presented through compelling narratives
  5. The best legacy is not one that is fondly remembered, but one that is actively emulated

Value is created when Silos Break down

In “What the Smart Money Wants from You,” Robert Kramer, Founder & Strategic Advisor to The National Investment Center for Seniors Housing & Care, shared Industry Data and offered his own insight toward three drivers that are influencing our vision and narrative for the future:

  1. The Longevity Revolution (Silver Tsunami)
  2. Data, Robotics and Mass Customization
  3. Healthcare Payment & Delivery Reform
“We always overestimate the change that will occur in the next two years…and underestimate the change that will occur in the next ten”

Bill Gates

American business magnate, Microsoft Corporation

In his engaging presentation, Bob Kramer offered his invaluable insight (replete with data metrics of course!) into the future of aging, how it is being redefined by emerging trends and the anticipated impact of “new retirees”. The later will be represented by “transitions” to encore professions as opposed to traditional retirement. Bob’s own circumstances are illustrative of this occurrence.  Having been recognized as the CEO leader breeding the remarkable success of NIC as the premier research, educational and data source for the Seniors Housing & Care Industry, Bob now transitions to Chief Strategist for NIC.  Undoubtedly he, like numerous other industry veterans, including the likes of John Erickson and Dr, Judah Ronch representing the Summit, will continue to influence and shape the future of aging.  These are not declinists but rather industry treasures to engage and leverage.

The Declinist view of Retirement where seniors unplugged to enjoy their golden years is clearly outdated (like the Silver Bridge) and being replaced by a new emphasis on engagement where residents will want to be become integrated with the communities they choose in an intentional and productive way. As the “diaspora” of healthcare continues and senior services become “uberized,” it will become increasingly difficult to compete with the demand for full service and retail “life management” solutions.  Lifestyle coupled with the presence of supportive care proving more intergenerational and “connected” will give rise to the trends of desire trumping needs. Where will we plug in to the new value equation as developers, operators, caregivers?   Imagine a future of aging where business constituents are more “collaborative” than “competitive”.  These trends are the leading indicators of integrative thinking (points from Dr. Ronch) and more integrated business models that emulate the real world.

Imagine a Cure for Alzheimer’s, Then What?

Scott Townsley’s session was centered around the assumption of a cure for Alzheimer’s. Whether or not a cure is on a horizon, this kind of open-ended / creative thinking enables us to focus on the survivable (or missing) attributes of our business and its offerings. Ironically, these attributes or amenities might actually define our core because they are likely “transcendent.”

“People don’t want to buy a quarter-inch drill, they want a quarter-inch hole”  

Theodore Levitt

American economist and professor , Harvard Business School

The traps of quality and superiority were addressed where the former represents the sentiment that well established organizations don’t need to change (until it is too late) and the latter assumes that a premium offering will also maintain its hegemony – except that customers ultimately crave simpler, cheaper incumbents. The final ¼” drill trap presented echoed the detriments of Marketing Myopia where we forget that we are selling solutions not widgets. If we are struggling to identify our own value proposition as an organization, this exercise creates an opportunity to highlight (and work to close) the gap between what we think we are selling (i.e. memory care) and what the market wants to purchase for themselves or loved ones (valued relationships and engagement).

 

Awe – using art to create relationships

If you are not aware, The Erickson School strategically front-ends the program with business and academic content and reserves the final book-end for local guest speakers that can help to ground and synthesize our thinking (by tempering it) with the raw emotional reality of people and their own first-person caregiving stories. Just before these guests arrived, we were primed for the transition through Anne Basting and a re-telling of her incredible work. She relayed how her experience of introducing the transformational power of theatre to people with memory care issues enabled them to engage instead of being alone together.

“The arts are a way of being in relationship, of seeing and shaping the world. My work brings the tools of imagination and creative expression to care relationships and systems in order to foster healing through community building. We cannot heal without story”

Anne Bastings

Artist, Scholar, Teacher, UWM Center on Age & Community; Founder, TimeSlips

It should not be surprising that an entertainment giant like Disney would proffer the same insights garnered from improvisational arts. Storytelling creates a safe space for everyone through abstraction – when you create an open environment, expression naturally fills the vacuum. What does this look like in the built environment? Or is architecture just a shell if it is filled with genuinely human activities? In any case, the challenge is not just how do we create a better physical space for Memory Care but rather, how can we establish a broader network of engaging human activities? We need life centers where everyone can thrive.

Short Circuits

To echo Atul Gawande’s essay once more, “Our ability to use information to understand and reshape the future is accelerating in multiple ways.” He continues to describe that “we have at least four major data inputs that reflect our health and wellness over time, (1) information about the state of your internal systems (from your imaging and lab-test results, your genome sequencing); (2) the state of your living conditions (your housing, community, economic, and environmental circumstances); (3) the state of the care you receive (what your practitioners have done and how well they did it, what medications and other treatments they have provided); and (4) the state of your behaviors (your patterns of sleep, exercise, stress, eating, sexual activity, adherence to treatments).”

When you consider the scope of these inputs, it becomes clear that we will need more bandwidth to capture all of this data and make use of it in a meaningful way. It is unlikely that a sole “hero” provider will venture off into the forest and return with a miracle solution for Alzheimer’s or any other dis-ease. Of course, if you have eyes to see and ears to hear, we might already be the miracle we are searching for.

“Remember, creative power will not operate itself. Knowing what to do is not enough. You, imagination’s operant power, must be willing to assume that things are as you desire them to be before they can ever come to pass.”

Neville Goddard

Author and Teacher

In this sixth year of the summit, we were all called to cultivate our iconoclastic quotient (IQ) so that the future we imagine is built on solid ground instead of crumbling foundations. We were also reminded that if engagement is the ultimate prescription, then we cannot succeed in isolation. Let’s take inventory of our respective strengths so that we can catalog and distribute the dimensional inputs of health and wellness together as due-diligence only. The shared moon-shot is to leverage the data and best practices to craft a new story about how we can age more actively and remain engaged together.

A New Message – Providers and “Enablers” should come together in Senior Living

A New Message – Providers and “Enablers” should come together in Senior Living

SAN DIEGO – In Messaging New Directions we relayed the general theme for the NIC 2016 National conference – that cost, value and messaging need data, analysis and connections if a clear narrative is to emerge for Senior Living. As expected, there was a newly crafted narrative shared at this year’s NIC 2017 Spring Forum and it was  informed by the confluence of data, analysis and some new connections. NIC engaged Anne Tumlinson to research the Board inspired thesis of creating value by intentionally coordinating bricks and mortar with emerging soft resources coined as “Enablers.” These findings became the framework for the NIC 2017 Spring Forum entitled “Unlocking New Value Through Senior Care Collaboration.”

Innovating Senior Care

The following NIC webinar provides a comprehensive introduction to many of the talking points that were expanded upon at the NIC Spring Conference:

NIC Webinar: Innovating Senior Care from National Investment Center on Vimeo.

Of note, Bob Kramer, CEO of NIC summarizes that, “Healthcare providers and payers are beginning to realize that if you are serious about delivering better health outcomes and controlling costs, housing as well as socialization matters, and in fact, without them you won’t achieve good outcomes.” There is a symbiotic opportunity represented by coupling asset-based providers with the care capabilities of so-called “enablers” and the captive customers they already represent – and can share strategically  – in order to scale together. Kramer noted a remark from CEO of Kaiser, Bernard Tyson  at the J.P. Morgan healthcare conference, that “40% of an individual’s health is driven by personal behaviors outside of the healthcare environment”. Recognizing the influence that non-real estate based providers of technology and services will have on the Senior Living sector is the first step toward breaking down silos of care.

Enabling by Example

Kelsey Mellard represented Honor at the event where they were the unofficial poster children for the disruptive (enabling) innovation our industry is being charged to embrace. Co-founder Sandy Jen’s brief TEDMED talk below captures their view on the impact non-medical caregiving can have on the cost and value of healthcare:

Jen describes how “unskilled home-care has always orbited outside of the traditional healthcare system of nurses doctors and hospitals and more and more, people are realizing that the home part of hospital to home is crucial.” She adds that it (home-care) can (1) reduce readmission rates, (2) increase quality of life for patients after discharge and (3) reduce the cost of provider health care to an aging population estimated to reach 84 million by 2050. In a recent Argentum post titled, “7 Innovations Changing the Aging Experience” Aging 2.0 Co-founder Stephen Johnston relayed that, “Emerging technologies have the potential to disrupt the senior healthcare market and thereby nudge service providers to improve their offerings.” If advice from NIC and their expert panels take root, it is likely that we will start to see a groundswell in active partnerships and collaborations.

The New World of Senior Care Collaboration

The Value Based Care (VBC) Revolution

The shift from volume to value in Post-Acute Care (PAC) is not going to be possible outside the broader framework that is mandating a transition from treatment of sickness to promotion of health. It is no longer sufficient to care for someone only when they are under your roof! When you recognize this, it becomes clear why an active focus on population health and wellness is critical. As tools and services that exist in the community become more sophisticated (and even ubiquitous) to consumers of all ages, it is imperative that senior living providers not fall behind. In the Forum’s opening session, leadership from Jupiter Communities, naviHEALTH and Optum relayed the following three key takeaways for success in seniors housing:

  1. Provide evidence-based care and show strong outcomes
  2. Educate both payers and traditional clinical providers that they (you) are a meaningful part of the solution
  3. Collaborate rather than compete with other providers

Referring to the “right” PAC setting will be a critical strategy for VBC since “43% of Medicare patients utilize post-acute care after discharge and there is wide variation in costs across each setting.” As stated previously, 84 million people will be 65 years old or older in the United States alone by 2050. Beth Mace, NIC Chief Economist and Director of Outreach, contextualizes that datapoint further by reminding us that today’s 82 year old resident was born in 1934 and is part of the Silent Generation. With all of the age wave and silver tsunami buzz continuing over the past few years, we are still years shy of the crest that boomers will represent for providers of housing, care and tech-enabled services. Now is the time to begin preparing for that certain demographic future.

Tweeting advice to the Industry

Thursday’s luncheon featured a panel discussion with Senators Tom Daschle and Bill Frist, M.D.

As the clip above reflects, we need to engage in a more active national conversation about our social contracts and the role our government should play in health care. Interestingly, Sen Bill Frist made multiple passive references to the role quality food and nutrition has to play in improving health and reducing the cost of care. Did anyone else hear this? Or was it just wishful thinking on our part? If we want to prove that we believe in breaking down silos, we might consider a 2018 NIC Spring Forum focused on the economic development and health impacts of advancing and deploying local food systems!

Takeaway from a Taxi ride…

Providence offered a clear metaphor for reinforcing the value of collaboration in the experience of my brief taxi ride to the San Diego International Airport. As I stepped onto the Bayfront Hotel porte cochere, I could see that there was a single taxi waiting. The attendant escorted a woman into the back seat and then quickly turned to me and summoned the next car in line. Asking if I was headed to the airport, I confirmed that we both were. Our two, four-door, five passenger taxi sedans began to travel down Harbor Drive on parallel tracks together yet alone. We arrived at the same gate, at the same time, and we both presumably paid the same twenty-dollar fare.

The over-consumption model that this story captures mirrors many of our contemporary business relationships and transactions. In this example, some outreach and collaboration would have created immediate value for the two of us. Moreover, who knows what we might have discussed and explored through the connection of common interests. Do we really choose to consume alone or have we been artfully conditioned to relinquish our collective buying power? We should not consider ourselves to be victims of a broken system – we are active players that can influence the rules of the game.

Interestingly, our industry predicament seemingly proves a microcosm of our world at large. Our communities, industries and nations need to honor a simpler mandate – we must always demand and promote more collective EFFICIENCY every-where and for every-one. These are habits that must be formed and refined if they are to take up permanent residence in our collective psyche. If we identify and optimize what is wrong in these daily details, the broader canvas just might correct itself. There is a clear opportunity attendant to the messages that NIC and others are developing for us. The challenge is to expand the scope of our inquiry and recognize through our actions not just that silos represent lost opportunities for added value creation – but that all of our silos are nested one inside of the other. When we celebrate acceptance of an expanded and more inclusive perspective, we must remind ourselves that their is an ever-widening circle to be informed by.  As in our own business practice, “Combining Capital with Care” seems like the formulary for success.

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