January 1, 2009 | by I Advance Senior Care

Aging With Choice: Coping with a changing marketplace

As aging services providers, your mission is clear: serve the senior community in a way that enables aging with dignity, grace, and security. However, a retirement community cannot serve residents that do not exist. To remain financially and operationally viable, you must continually reevaluate the market context in which these services are provided.

Today’s senior is more independent, more active, and more selective than ever before. And, fortunately for him or her, an abundance of aging care alternatives exists where once only limited choices were present. Who is this new senior, and how does your community appeal to this upcoming generation?

Before answering this question, it is first necessary to assess the existing conditions of your community—in short, has it already been affected by the “Aging With Choice” trend? Evaluate your community for the following “warning signs”:

  • Are your independent living units (ILUs) turning over?

    Or are independent living residents staying in their units longer than expected? Operationally, this presents a financial challenge to your community, as new entry fees are needed to maintain your viability. After all, if residents aren’t transitioning from ILUs to assisted living units (ALUs), you can’t resell the unit.

  • Are your staff spending most of their time marketing assisted living instead of independent living?

    Today’s senior doesn’t want to move to a retirement community for the lifestyle; rather, they move only out of necessity. How do you change that focus and market that level of care more effectively?

  • Are residents “hiding” in your ILUs?

    Rather than move out of their independent living apartments/cottages when they begin to require additional help, many residents are turning to community-based home care and home health service providers, or are relying on their healthier neighbors for assistance, while attempting to keep a low profile to avoid transfer consideration.

  • Are you experiencing a significant service creep in your more independently oriented units, and are your larger ILUs becoming increasingly difficult to market?

Each of these “warning signs” is symptomatic of a larger change in the senior community, which is transitioning from the “G.I. Generation” to the “Silent Generation.” As a result of this transition, you must change your perspective on how to best provide aging services and maintain your community’s long-term success.

Generational contrasts

The G.I. Generation that past marketing efforts have focused on came of age during the Great Depression and the World Wars. They were victorious soldiers, the first astronauts, and an innovative generation of problem solvers who greatly valued a sense of community spirit.

By contrast, the “Silent Generation” now coming of retirement age is highly self-dependent. They defiantly desire to perpetuate their youth and resist aging, and consequently maintain healthy, active, and adventurous lifestyles. This generation does not seek a traditional retirement—many of them are instead seeking personal fulfillment through a second career. Retirement is something they will consider in the early to mid-80s but certainly not in their late 60s or early 70s.

The Silent Generation rejects traditional retirement communities as a lifestyle choice. Their perspective on retirement is significantly different from past generations’, and they view traditional retirement communities as a sort of “elder ghetto” that they distinctly want to avoid. They don’t desire to grow old with only “old people,” nor do they desire to surrender much of their personal freedom to someone else’s idea of how they should live or be cared for.

This generation of aging adults is, however, willing to downsize their homes and look for a community where they can be challenged and engaged, as well as pampered in a luxurious setting, should their finances allow. Age-restricted communities, both rental and equity-based, appear to offer what many in this generation are looking for. In these communities they want to volunteer, to learn, and to live a leisurely lifestyle. Perhaps most significantly, this generation appears willing to move into a traditional retirement housing setting or CCRC based only on actual need.

The Silent Generation’s motto embodies the Aging With Choice culture: “I want what I want when I want it, and only when I want it will I be willing to pay for it.”

How does Aging With Choice affect your community, and what steps can you take to mitigate its effects? Traditional responses have included community repositioning of its elements, such as upgrading or building new ILUs, ALUs, Wellness Centers, and “household” modeled skilled nursing facilities (SNFs), and adding newer and more varied dining venues. Yet, these reactions have proved to be less than adequate for adjusting to the culture of Aging With Choice.

As already noted, today’s seniors, more than ever, have a plethora of quality housing and healthcare options to assist them in the aging process, resulting in a reduced “need” for the services most traditional retirement communities provide. Aging services are increasingly available outside the confines of the traditional retirement community. If today’s senior can receive care within the comfort of his or her own home, why should he or she move into a retirement community?

Accordingly, several alternatives to traditional retirement communities have evolved over the past few years, and they reduce the perceived need for the services your community provides. Although not limited to the following, some of these substitutes include:

  • Extended family living. The resident’s home is the CCRC’s biggest competitor. In the United States today, there are approximately 3.1 million extended-family households. Especially common among new immigrants, these families either accommodate elders within an existing residence or add on to the home to provide for the additional needs of a senior family member. However, extended family living often presents privacy issues, as well as the challenge of providing an adequate level of care to the senior in need of assistance.

  • Virtual CCRCs. “Virtual” CCRCs can embody many forms: Aging At Home Initiatives, Naturally Occurring Retirement Communities (NORCs), and Faith in Action Programs. These community initiatives provide household services, concierge services, and social and cultural activities, as well as transportation and meal assistance, all within the senior’s home. With affordable membership fees, at-home initiatives such as this provide a support network for the senior to continue to live in his or her own home for as long as possible while still connecting socially and spiritually within the community. Some are volunteer-based, offering “time credits” for exchanges of services within the community. Examples would include Partners in Care, of Saverna Park, Maryland, and Beacon Hill, of Boston, Massachusetts.

  • “New Freedom” Initiatives. Seventeen States have adopted some form of the federal government’s “Money Follows the Person (MFP)” program, which enables seniors to use their Medicaid benefits in a variety of publicly funded programs. Options for MFP care under the New Freedom Initiatives include the Consumer Directed Waiver program, which gives the senior the ability to hire one’s own personal caregiver, Home First Initiatives, which help seniors in nursing homes return to the community, and the Program of All-inclusive Care for the Elderly (PACE), which includes proactive approaches to preventive care and wellness for the aging.

  • Technology advances. Today’s seemingly endless technology advances have made it increasingly easy for seniors to remain safely in their homes while still receiving the healthcare support they require. New technologies now make it possible for cardiac functions, blood sugar levels, wound healing, and other indicators to be remotely measured at designated times, with the results being digitally conveyed to a healthcare provider. Moreover, the Centers for Medicare & Medicaid Services (CMS) is currently funding trials of the Medical Home which provides for care monitoring outside of the context of a traditional setting, such as a SNF.

Addressing Aging With Choice issues

Understanding that the existence of these alternatives makes it more difficult for your community to compete in the marketplace, what should your community do to address Aging With Choice?

First, remove your focus from the “bricks and sticks” of your community and recognize that your community’s true value exists in the services it provides. When the walls are removed, new opportunities for your CCRC or care facility to integrate itself into the surrounding community will arise. Developing your services beyond your physical community—and thus becoming a preferred provider of healthcare outside the confines of your facility—adds increased perceived value to your operation and enables you to compete with those other long-term care alternatives now available. In line with this, consider adding adult day programs, meal services, transportation service, and other supportive resources to the menu of services you provide to the community at large. You will extend your market reach beyond the walls of your facility.

Additionally, reconsider the way you regard your facilities themselves. Arrange your units so that the services provided define the level of continuum of care that the resident occupies rather than the specific place. Create flexibility in the design of your units, allowing an ILU to become housing with services, as opposed to requiring a move to assisted living or assisted living to become skilled nursing or skilled nursing to be utilized as a Dementia Care Unit. Increase the number of your apartments and decrease your cottages, creating smaller, greener units that retain a unique and personal feel and that are safe for ambulating about.

Include amenities in the units that attract the senior market you serve, such as master suites, upgraded appliances, and an option for high-end finishes. Consider using a household model for skilled nursing, and use available evidence-based design data to provide added value for your residents and staff. Separate your amenities from your housing, but keep distances manageable, to create a “one-stop shop” for services.

Finally, rethink your operational, marketing, and financial strategies. In marketing, consider removing the word “retirement” from your community’s name and target your true demographic: the older, frailer senior who has increased need for services. Marketing your true value, i.e., the services you provide, will be more effective than attempting to market the shelter itself.

Operationally, realign your staff to include universal workers instead of specialty personnel. Acquire new or unfamiliar operational skills through acquisition or partnership, and be willing to partner with technology to improve your community’s efficiency. Make sure, along the way, that you are able to clearly define your operating costs for each level of service or care.

Financially, realigning your community to adjust to Aging With Choice initiatives will likely result in the need to reevaluate your contracts. You may find the need to re-price entrance fee contracts if they are refundable, and you will need to determine whether a “life care” element should be included. From your consumer’s perspective, choice in contracts is good, enabling them to align what is valued as a service with what they want to pay. Of course, from the perspective of a provider, entrance fees are essentially “prepaid” monthly fees and any choice in contracts must be evaluated from this context. Your community must understand the parameters that drive financial considerations among contract types to ensure ongoing viability. Additionally, because cash flow profiles differ over the lifetime of a consumer, your community must understand the various “timing” implications of your contractual agreements, keeping flexibility in mind.

Conclusion

Whether or not your community is already being affected by Aging With Choice trends and initiatives, it is imperative to look to the future to prepare for the changing marketplace. Even the most successful and dominant communities should heed the example of the Schwinn Bicycle Company. At Schwinn’s peak, the company owned the overwhelming majority of the U.S. bicycle market and was considered to be the best in the country. However, Schwinn failed to adjust to the changing marketplace or to consider the evolution of the bicycle into specialty subsets. The eventual popularity of the mountain bike, the acrobatic bike, and the racing bike soon ate away Schwinn’s market share. On September 11, 2001, Schwinn Company was bought at a bankruptcy auction by Pacific Cycle, whose CEO was quoted as saying, “The Schwinn name is an American icon. It is the brand that many Americans grew up with and aspired to own. We feel that we offer the best opportunity in a generation to restore vitality to the Schwinn brand.” Through this buyout Schwinn plans to redefine its place in an industry it once “owned.”

Schwinn’s story can teach our industry a powerful lesson: We must always be preparing for a changing marketplace. Aging With Choice is an opportunity to reposition your community so that you may continue to provide the aging care services that represent your most important mission.

Bottom line: You won’t get to your future through your past. Focus on what the future is really asking of you.

Beverly Brandon is Vice President of Senior Living and Design at REES Associates, Inc., and can be reached at

blb@rees.com. Elizabeth Flury is Director of Clinical Integration and Aging Strategy at the Johns Hopkins Health System and can be reached at

ebartle9@jhmi.edu.

To send your comments to the authors and editors, e-mail brandon0109@iadvanceseniorcare.com.

Long-Term Living 2009 January;58(1):14-18

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