Bickford EVP: Current Assisted Living Model May Already Be Broken, We Must ‘Disrupt Ourselves’

Bickford Senior Living Executive Vice President Alan Fairbanks believes the writing is on the wall for private-pay assisted living.

By that, he means he can see a day in the not-too-distant future when care coordination and value-based care upend normal business for many senior living operators.

“We better begin to think differently as an industry in trying to protect and hold on to this private-pay assisted living world, because it might not be in place very much longer,” Fairbanks said on a recent episode of the Senior Housing News podcast Transform. “We need to disrupt ourselves, we need to be open to that disruption and not try to hold on to the sins of the past.”

To Bickford, the “sins of the past” include senior living operators not being proactive enough with meeting the care needs of their residents, and not being quick enough when adapting to the new paradigm of value-based care.

Bickford is furthering this vision with a home care line it launched last year.

“This is not a feeder source for assisted living,” Fairbanks said. “This is about bringing care and services to the seniors wherever they are, and doing everything we can to keep them out of the hospital.”

Highlights of Fairbanks’ podcast interview are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts and SoundCloud.

On Bickford’s Covid recovery:

We’ve certainly seen some really positive trends in occupancy here recently.

We haven’t reached pre-pandemic levels yet. We’re getting close to that, but we’re still not there yet. And we had a really, really good ramp up here recently. What we’ve seen in February and into early March, it’s been a little bit of a challenge. And as I’ve talked with other operators, they are kind of seeing the same things.

We’ve had an exorbitant amount of move-outs. Most have been related to death. We are very good as it relates to leads and sales and move-ins and occupancy — all certainly were trending in the right direction. But the move-outs have caused us to have a little bit of a pause in that ramp-up period we were experiencing.

The demand is there, the sales have been really strong, leads — all of those metrics that you really want to be positive from an industry standpoint have been, so that’s been a really good trend that we continue to see is the number of leads and number of sales and movements. The demand has certainly been there.

On Bickford’s home care aspirations:

We’ve launched the initial four [agencies] and they’ve gone really well.

It’s been a little bit slower than what we anticipated, primarily due to the balancing of caregiver and clients. That’s always really a nuanced part of home care, and certainly we knew that stepping into the situation, which is why we partnered with HCAN. We knew we weren’t experts in home care, and there were things where we were going to have to lean on them to help us navigate, and they’ve done that.

We have really started to see some good momentum recently in those four areas that we’ve initially launched, and enough so that we continue to be very bullish on home care and the direction we’re going. We actually are in the process of launching three new markets here in the next 30 to 45 days, and it’s our intention to launch a total of 10 markets by the end of this year, which will bring our total markets to 14 for home care. So as you can see, the trends have been positive enough for us that we really feel like this is a real opportunity for us in multiple markets.

I think that’s ultimately what seniors want. They don’t necessarily want care, they want independence. So how can we help serve them, and how can we bring that to them? And that’s when we really began to think about home care, and bringing care and services to an individual in their home. We’ve been in the senior living industry for 30-plus years, we know how to provide services for seniors. Why would we limit ourselves to the four walls of assisted living, when there’s such a need out there for care and services beyond that? And that’s when we really started thinking about how we can best do that, and that’s when the idea of home care came about.

We knew others had tried it, others had failed. And again, that’s why we leaned on the relationship of individuals who have done home care in the past and know how to operationalize it and make it work. And it has worked, it has been successful for us.

Why others have failed is that they stepped into the home care world looking at it like this was a feeder source for assisted living. That’s not what this is about. For us, this is not a feeder source for assisted living. This is about bringing care and services to the seniors wherever they are, and doing everything we can to keep them out of the hospital.

Regarding the biggest challenges, one obviously is caregiver recruitment and finding how to best balance the needs of caregivers and clients. In the home care world, it seems like you always have too much of one and not enough of the other. You have too many clients to try to serve, and none of the caregivers; or you have too many caregivers that want hours and don’t have clients.

It’s been the learning of that nuanced way to handle the caregiver or client ratio and balance those out. That’s been a challenge. But one of the biggest challenges, I’ll readily admit, was our ability to really clearly communicate our vision for home care to our own people. It’s seen still as a competition for assisted living. We’re working hard to overcome that, and it’s getting much, much better. I personally underestimated how much communication needed to happen to clearly communicate our vision for home care to the entire organization.

On the benefits of starting a home care business:

It’s certainly begun to pay off. There are huge benefits yet ahead of us, for sure.

Some of the ways it’s begun to pay off are stories about individuals that were considering moving into Bickford assisted living, and didn’t choose to make that decision yet. But yet, home care was able to step in and provide care and services for them in their home, to allow them to stay home longer than maybe they would have initially.

One of the biggest things that we’re really beginning to explore and think differently about is the whole idea of staffing. I don’t need to talk about the staffing challenges that the industry faces. They’re real, they’re here, and they hurt. But what we’ve learned is, my ability to recruit caregivers to the home care space has been easier than recruiting them to the assisted living space. Now, granted, I said easier, I didn’t say easy. It is still challenging, and it’s still hard.

The learning that I’ve taken away from that is, why is that? I think it’s because of the flexibility that we’re offering to the caregivers in the home care space. At the end of the day, I believe that’s what our caregivers in assisted living want, as well. We’re trying to move in that direction as an industry, but we’re slow. It’s like trying to move a battleship and change course.

What we’re beginning to realize is, there is some technology and resources and things that are available to us in the home care space that we are really beginning to look at and engage differently with this whole idea of staffing, and how home care can help support staffing from an assisted living standpoint. That has gotten me more excited about staffing than I have in a long, long time.

I really am excited about what opportunities we have before us, and that wouldn’t have materialized if it wouldn’t have been for our experience with home care.

On what the industry is getting wrong about offering care:

I should probably lead with I lump ourselves in that same category, so I’m not here in a glass house throwing stones.

What happened is that, in general, our health care system today operates within what I’m going to call a “sick care” system. We wait for something bad to happen, and then we bring care and services in and react to that negative event. That’s the system that we live in today, and that’s where I feel like there’s tremendous opportunity for us as operators to transition into a more of a “well care” system — a healthy aging type of model [where] we recognize the benefits of what seniors bring to all of us, and get on the front side of some of these negative events and not just wait for bad things to happen.

We can be more proactive in the care services that we bring by creating [relationships with] these providers that can come in and be in relationship with us to meet the needs of a senior, versus just waiting for something to happen. Let’s talk about the seniors with the primary care physician, with the home health, with the home care, with the hospice companies, with the behavioral health network — let’s talk about the seniors on a regular basis, every single month, to get them on the highest path possible.

We talk about giving them their golden years back versus them just coming into one of our locations, and then just being there waiting for something bad to happen. We talk about ageism all the time. I think there is some ageism that exists even with our own industry regarding what happens when someone moves into assisted living.

Let’s be proactive, let’s keep them on the highest path possible. You have heard me use the term healthier, happier longer — well, let’s really do that. And let’s just not do that in isolation of ourselves. Let’s get this provider care network involved in these conversations, and do it proactively versus reactively waiting for something bad to happen.

On how senior living operators can be more proactive with care:

My view of this is, it’s not necessarily costly from a standpoint of dollars and cents and capital, it’s simply costly in the sense of taking the time to actually meaningfully do it, and put a provider network together, go out in your communities and be in relationship with other providers, set those expectations of what it will take for them to participate in your provider network, and then hold them accountable to those expectations that you set and have in place.

When you think about private pay assisted living and protecting that — that may very well become a dinosaur in the next three to five years. [Fifty-four percent] of middle-income seniors can’t afford assisted living services in the year 2029. Well, last time I checked, that is seven years from now. So, this model of care may already be broken. And if it isn’t now, it may very well be broken very, very soon.

We better begin to think differently as an industry in trying to protect and hold on to this private-pay assisted living world, because it might not be in place very much longer. And when I think about the direction we need to go, that’s what I think about. We need to disrupt ourselves, we need to be open to that disruption, and not try to hold on to the sins of the past.

So, I do think there are opportunities here to create these networks of care and to get in relationship with physicians and get in relationship with these other providers. They want that as well, because there’s too many dollars at stake here from the insurance side. What is health care now, 22%, 23% or 24% of our GDP? We’re talking about trillions of dollars. And if we can do a better job of taking care of seniors — and who has more opportunities than us as an industry? — then I think we can show value and harvest some of that value that can be available to us in the systems of the future.

So, I don’t look at this as trying to protect what we have. This is about blowing up what we have, and let’s try to create a new model, a better model, that meets the needs of all seniors.

On Bickford’s growth in 2022 and beyond:

We’re continuing to grow the core business.

We’ve got a new branch opening in 30 to 45 days in Virginia, so we’re going to continue to grow the assisted living part of the business. As I mentioned previously, we’re going to continue to grow home care, and we’re getting ready to launch hospice in a couple of markets.

But our biggest focus beyond that is, again, stepping in a much more meaningful way into this provider network … and a model of health care that we think the industry needs to move toward.