Over a career spanning about two decades, Belmont Village founder and CEO Patricia Will has earned the status of senior living changemaker.
From mixing levels of care within a single building to developing early-stage dementia interventions to forging university affiliations, Will has led the way. Today, she continues to push the envelope with a first-of-its-kind partnership with health system Baptist Health, to co-develop senior living communities. She also is pursuing ambitious international development plans, and a new approach to unit design.
Houston-based Belmont Village now has a portfolio of about 30 buildings but maintains the spirit of a startup, Will said in her Changemakers interview. Still, having a more mature business infrastructure allows her to take on even bolder projects.
What are some changemaking efforts you’re most proud of, within Belmont Village or the industry as a whole?
The first is a simple one, which is including independent living, assisted living, and memory care under one roof, in one building that’s fully licensed.
We did that in an effort to accommodate couples, and in an effort to fight ageism. There’s a notion that people would object, in independent living, to seeing walkers or wheelchairs, and we decided to say that we have capable people who have different needs, and we don’t want to segregate them. That’s something that we did for the very first time on our first building in California, in San Diego, and we’ve now replicated in many parts of the country, although it’s still not done enough. We’ve integrated dining rooms, integrated gyms, integrated social areas and even integrated floors.
Can you take me back to that moment when that was still a new idea, to integrate in that way?
Everyone in the industry at the time said, “You’re crazy. The independent seniors will not come to live here. They don’t want to see frailty in the dining room … in the common areas.”
And we said: “Wait a minute, who is the senior here?” And the senior is 85 [years old] regardless. The issue is whether or not they’re experiencing physical or cognitive frailty. And as a couple, what are you going to do? Tell one to go live one place and one to go live in the other place?
So we said, “This is a big bet, but we’re going to integrate service, and license the whole building so that the senior in independent living who needs medication management can get it or can get assisted living services post-hospital stay and eventually in their unit.” That was now 18 years ago. The building [in San Diego] has done incredibly well. We’ve used the same algorithm over and over, including in all of the projects that we’ve done in affiliation with universities.
We even pushed it further, and in our mid-rise buildings and high-rise buildings, many of them share floors, share elevators, share common area spaces, and I think it exemplifies what we’re after, which is a contra to ageism that typecasts individuals because they appear to be frail.
That integrated model is now well-established in the industry, but you think it’s still not done enough?
No, it’s not done enough.
You still see a lot of communities where if you need assisted living, you need to move to that other building, to that inferior space, to that place where nobody wants to go. That’s unfortunate.
Other changes you would highlight?
This would probably be my second proudest moment: Recognizing the need for highly developed programming and curricula for those that are in assisted living — or independent living, by the way — who are beginning to experience mild cognitive impairment. The research tells you that if you hit on five or six cylinders in a very deliberate way with highly trained people and you measure the outcomes, and we do, that you can change the trajectory of memory loss.
We took a look at that and said, “Wow. I wonder how many people living in assisted and independent living with us could benefit from such a deliberate curriculum.” The answer was: a lot.
So starting in about 2007, we began working on this intensively, and developed programming for those who don’t need to live in secured dementia [housing]. At first, it was five days a week, and then seven days a week, and now seven days a week and into the evening.
The program has been studied by Vanderbilt University. What we’ve learned is that, one, residents who experience mild cognitive impairment can thrive within assisted living, and also that it’s possible, as I said, to change the trajectory of the disease process. That’s a mind-bending accomplishment, particularly for a disease process that still has no medicinal cure.
To focus on a change-making effort underway today, can you describe Belmont Village’s partnership with Baptist Health?
What we see now is a lot of excitement around the convergence between what we do — seniors housing and care — and pure health care.
If you think about it, who are the largest customers of pure health care? Seniors. The notion here is that if you extend the continuum with an objective of keeping seniors out of the big hospitals and look at everything that can be accomplished with respect to physical, psychological wellness and prevention, that you really have something.
Baptist was willing to stick its neck — and its balance sheet — out and say, “This is something that we want to pursue.” It’s very interesting, because if you talk to their physicians and their board members, this is something that they’re deeply excited about. And being in South Florida, where there’s a dearth of high quality seniors housing and care, they also, like us, saw the need, and said somebody needs to be doing more of this here.
What we see now is a lot of excitement around the convergence between what we do … and pure health care.
I think that our job is to take the best of what they know and render it in a manner that fits within the high-quality hospitality envelope, and see if we can’t make something better than what exists today, where seniors prosper and stay well for a longer time. I think that convenience is going to be a factor in this, and we are having a lot of conversations about how to use telemedicine effectively.
Our first project is going to have a really dynamite senior wellness and prevention center in the base of the building. It will be open to the public, but also fabulous for our residents, and we’re going to keep pushing the envelope. I’m not sure where it winds up. That’s part of the excitement.
It’s also a real estate play for the health system, correct?
It’s an investment play, and it’s a business diversification strategy for the hospital system. That is to say, they see the promise in this business, and the opportunity, yes to partner strategically, but also to create earning assets. They’re our partner.
Let’s talk about Belmont Village’s entrance in Mexico City, with a major mixed-use project. What is the vision?
The vision there is, one, to create best-of-class seniors housing and care within the envelope of mixed-use buildings. I think the experience that we’re having there with that is an experience we’re going to take back to urban America.
But at the end of the day, another driver in creating what we’ve done there is to get great experience becoming an operator with a formidable operating organization in Spanish, so that eventually we could go to what I call Phase Two, which will be to create best-in-class communities in more the resort areas where Americans — particularly from large markets like L.A, San Diego, San Francisco, Houston, Dallas, Austin — have spent every year of their lives for spring break. What we can create there with great hospitality, very affordable and high quality health care services, is the product that we do in L.A. [but] for a lot less cost. There, you’re looking at the ocean, and instead of wine and cheese on Friday night, it will be margaritas.
You’re also changing the way that Belmont Village units are designed. What’s behind that change?
When I started in the industry and we started building, we were building boring studios. We were prepossessed, as we have to be, with accessibility. But accessibility doesn’t always work very well for seniors. We have to be able to make spaces that are workable. In general, we’ve seen across America people wanting larger spaces than we ever imagined. We need to design for the end user and assume more capability than we gave them.
I’ll tell you, it was mind bending to see my mother, a tall statuesque woman, move into a Belmont Village; and actually, she wouldn’t move until the largest unit available was available. They had two bathrooms, one for my dad and one for my mom, because she said, basically, I haven’t shared with him in ever, and I’m not going to start now.
Even with all the study we’ve done, situating her and seeing how a typical woman functions in a bathroom — where do you put your stuff, where do you plug in to blow dry your hair, what about a makeup mirror — a little bell went off, and I took out a piece of paper and I made her unit work for her. What do you do with all that empty space in an ADA [Americans with Disabilities Act] unit for somebody who doesn’t need the accessibility between the toilet and the sink? Why is there not enough counter space? We’ve gotten to work on that and we’ve had a lot of discussion. How is the refrigerator used? What are the upper cabinets for? Where do you store stuff?
You start thinking about the livability, and man, you can make it better, and the residential [developers entering senior housing] have a big leg up on us there.
Is it a systematic unit renovation project that’s going on now?
We have a systemic unit renovation project going on, and then in our new builds, we’re pushing that even further.
To extend in your existing buildings, you can only do so much because you’ve got the spatial requirements that are already set. But even there you can do quite a bit, and we’re also doing experiments. I have two different new kitchen designs being built out as we speak. And we’ll look at both of them and say this is better, that’s better. It’s exciting.
Timing is always tricky for a changemaker, right? Getting ahead of the curve but not too far ahead, and being patient for projects that need a long lead time.
It certainly takes vision and persistence, and then a willingness to step outside the box. In most industries — not just the seniors housing industry — that’s true. It also takes patience and long-term point of view, because none of these things happen quickly. None of the buildings or sites happen quickly. Partnerships with universities, institutions, and those kinds of things need to be nurtured over a long period of time. Some of them don’t happen at all, so you have to be willing to invest time and overhead.
What’s really interesting about that is that a lot of things come back around. They may not work at the time and you may kiss each other goodbye or the site goodbye or say this is an idea whose time quite hasn’t come, and then two or three years later it resurfaces maybe in a slightly different form and you say, “There it is. Let’s go.”
We have always been long-term players. Another thing that distinguishes us is we still have meaningful ownership and operate everything we’ve ever made. That’s unusual. But I can’t think of anything I’d rather own. If you have that long-term point of view, then it kind of fits with pushing the envelope a little bit, understanding that you’re going to make mistakes or something won’t work and [you can] say, “OK, never mind. Let’s try something else.”
How long do you give it? Do you believe in “failing fast” and moving on?
I think it depends on what industry you’re in. Obviously, wanting results now and wanting to have them fast and even the notion of a first-mover advantage very much fits, for example, with tech.
What I would tell you is that we have a startup today with the luxury of 20 years of operating experience underneath us, terrific infrastructure, and the luxury of being able to afford to experiment without fear of abject failure. There’s no way I would have built a Mexico City [community] or spent seven years nailing Lincoln Commons in our maiden voyage, because I would’ve gone out of business. Whereas today, we have that infrastructure and experience. The problem with being 20 is you have to challenge yourself every day to [overcome] the inertia that sets into an organization that says, “This is how we do it.”
You have to bring in new talent from different businesses to question that and think outside the box.
How do you respond when people tell you you’re crazy for an idea, like mixing levels of care in one building?
Well, you have to listen.
When we built our first community in Houston, about a mile from the Texas Medical Center in a neighborhood that I lived in, I put 160 units of assisted living on the ground, and nobody had built an assisted living community of more than 60, 80 units. My competitor on that building was the first Marriott senior living, which was about a mile down the road in the other direction. Bill Marriott called Bill Sanders, who was the head of my equity partner at that time, and said, “That blonde woman that you have is crazy. You will never fill 160 units of assisted living.” By then, we were just getting under way, and Bill Sanders called me and said, “You signed on this thing?” And I said, yes sir. I said further, if this doesn’t work, there’s nothing you can do with it. It’s very special purpose.
I said, if it doesn’t work, you can have it back and you can have my two teenage children. That’s all I’ve got to give you. That was scary. You can be headstrong, but you also have to be smart. I reasoned at that time … if in a great residential neighborhood in the fourth-largest city in the country, a mile from the world’s largest medical center, the Texas Medical Center … if I can’t fill 160 units, I need to end it. In two years, we filled it.
That must have given you confidence early in your career?
You have scary moments. I couldn’t have had too many of those back then. I was betting everything.
When I decided to do Mexico City, even my own guys were saying, “There goes Patricia coloring outside the lines.” But if you don’t do that, you run the risk of becoming obsolete.
I think if there’s a risk in our industry right now, it’s not to take on the challenges that innovation has demanded of us in terms of … what it all looks like and how integrated it is with health care. Do you forget the care piece and just make it beautiful? I really think it demands every day saying, “What are we doing here?”
I think we have to be very careful as an industry now. We are nowhere close to taking care of the boomers. I’ll be taking care of them 10, 15 years from now — the very first, maybe — if we have the kind of advancements that we’re continuing to have in health care even longer still. Why? Because basically the people who get their knees replaced and their hips replaced and survive cancer and heart disease are typically not looking or needing assisted living any time soon.
I think we have to be very careful as an industry now. We are nowhere close to taking care of the boomers.
There are the exceptions — dementia, Parkinson’s and so on — but I think we have to be very careful. There’s a difference between innovating even for who we have now, making more intelligent decisions with respect to how to keep everybody out of the hospital, and integrating technological and medical innovation into our buildings.
Can you describe a time when you were trying to make a change and it didn’t go well?
On the investment level, around the time of the recession. We had always been, apart from our own capital, backed by institutional investors, and that served us very very well. But there was this time where that didn’t appear to be feasible. We rather looked to high net worth wealth. That did not work out well for us.
What we found is that the backbone and analytics of institutional investors were much more suited [to Belmont Village] than individuals — apart from ourselves — because this industry requires aptitude and patience, and deep pockets. That was a unique experience, and we’ve never done it since. We happily got those investors out whole and happy. But we learned that we are a complex business, both on the real estate and the operating side, and we’re much better matched with institutional players.
What traits or skills make you an effective changemaker?
I think that we are decidedly informal as an organization, and I think that’s a positive because we still look and feel pretty entrepreneurial. I think that’s good, but obviously we’re in a business where rigor and structure matters. There’s a tension there all the time. We’re in a business where experimentation is great, but performance matters. At the end of the day, we’ve got to earn a rate of return for our investors or there won’t be any capital. And then finally, as I said earlier, there’s the new and the old. We have a wonderful organization of people who’ve been with us for a very long time, but the danger there is the refrain, “This is how we do it,” as opposed to honoring the ideas of people who are coming from other organizations, other environments, other industries, or who are just a different generation and see things through a different prism. They’re all fun tensions to manage, but it can be taxing.
How do you keep pushing for change after 20 successful years? You mentioned bringing people in with new perspectives.
You have to do that. I love our millennials. They are transforming the way we think about a lot of things. We’re bringing people from outside the business altogether.
It’s a challenge for us because I think we may be the most tenured company in the business. It’s got to be a balance, and you’ve got to make sure, and it’s hard, that the tenured talent that you have doesn’t run off [due to] the new ideas. You’ve got to mix it up, or else you’re going to die.
Do you think the senior living industry as a whole is changing fast enough?
With the big age wave in front of us I believe that the current rate of change is fine. That said, the next 10 years must be transformative. Without substantial innovation the industry will not be able to withstand demand pressure for cost effective solutions.