A Vision of Senior Living’s New ‘Wellness Era’

Last week, Senior Housing News was thrilled to convene a tremendous group of industry leaders and visionaries at our WELLNESS/DISHED event in Orlando.

“The … meeting sparked some of the best discussions I’ve been part of this year on how we can improve and better support the physical, social, mental, and overall wellness of those we serve,” Rendever’s VP of Sales Nicholas Abruzzo wrote on LinkedIn — and I agree.

As I’ve processed the many great ideas and insights from the event, a vision of the wellness-driven future of senior living started to emerge.

In this week’s exclusive, members-only SHN+ Update, I analyze themes from the event and offer key takeaways, including:

• Senior living is at a major historical turning point, embarking on what could be called the “wellness era”
• Providers must be more attuned and responsive to consumers’ individualized wellness goals and needs
• New wellness-oriented staffing and marketing models are needed
• Providers can become market leaders by being trailblazers in next-generation wellness 

A new chapter of history

Never before have I been at a senior living event where the panelists spoke so much about history and took such a long view.

In her keynote talk, Mather CEO Mary Leary pointed out that the typical, six-dimensional model of wellness utilized by many senior living providers was developed 46 years ago.

“To put that into context, residents in senior living communities in 1976 were born before women were given the right to vote, as well as people who were at the tail end of the generation born immediately following the Civil War — so wellness was certainly not top of mind for these folks,” Leary said.

Juniper Communities CEO Lynne Katzmann also looked back more than 100 years.

“Think about lifespan in the U.S. in 1900; the average person lived to age 46,” she said. “In the year 2000, it was 77, and today 50% of all five-year-olds will reach their 100th birthday. So lifespan is not our issue. Our issue is the quality of those lives.”

In 1900, the top killer was pneumonia, whereas currently 70% of people die of chronic illnesses such as heart disease, she noted. So, medical and pharmaceutical interventions have become less important than lifestyle management in extending people’s lives and their wellbeing — a concept Katzmann referred to as “wellspan.”

And Dr. Bill Thomas of Eden Alternative, Green House and Minka fame — and currently the Chief Independence Officer at Lifespark — also referred to the grand sweep of history.

“We’re in the middle of a shift between two historical periods,” he said.

Specifically, the long-established fee-for-service health care model is being replaced by value-based reimbursement, in which providers — including senior living providers — have the opportunity to get paid for driving people’s health and wellness rather than treating their illnesses and injuries.

In fact, the “value” in value-based reimbursement is wellness, he argued.

“And who is better positioned to cultivate wellness among frail octogenarians who aren’t in a position to be living on their own in the community?” he asked, referring to senior living providers. “Through value-based reimbursement, that adds a line to your profit and loss statement, where you have your traditional sources of revenue and then you type in, for the first time in your career, you type in a new revenue line on your financial statement.”

In short, if senior living providers want to thrive in this new era of history, they must modernize their approach to wellness in order to attract and serve the new generation of consumers by supporting “wellspan,” and get paid for doing so by adapting to the new health care paradigm.

An individualized approach

As for how senior living providers can achieve these goals, many different ideas and approaches were put forward at the event. But a consensus emerged around one key concept: The future of senior living lies in an individualized approach to wellness.

Here are just a few relevant soundbites:

• “Anyone in here, you or I, we have different versions of how we want to get well. So we need to attend to each individual person and motivate them in their way.” — Jolene Moore, director of operations, Pathway to Living
• “We’re being much more diligent and listening to our consumer, either those who live on our campuses or are thinking about it, because we feel there’s unmet needs.” — Doug Leidig, CEO of Asbury Communities
• “I really think that the use of data to personalize the experience is the future, and again, figuring out how do we use data to tell a story and then apply that in a meaningful way to help personalize the resident experience.” — Michelle Wright, VP of Marketing, Caavo
• “For us, it’s really about understanding the individual, not only the residents, but their family as well.” — Iyvonne Byers, CFO, Priority Life Care

An individualized approach to wellness makes sense in terms of value-based reimbursement, because the more tailored a wellness program is to a person’s health risks and lifestyle goals, the more likely that person is to adhere to the program and avoid costly medical episodes such as hospitalizations. And avoiding costly interventions is the key to lowering health care spending and driving financial rewards within a value-based framework.

Katzmann has been a leader in bringing senior living into this new health care era, partnering with other providers to launch Medicare Advantage plans designed for senior living. Last week, she spoke of individualizing wellness to create “lifestyle prescriptions” that are unique to particular people. And she is open to harnessing a variety of tools to achieve this objective, including genomics.

Lifespark — which involves not only a senior living platform but an entire network of home- and community-based services — also is bringing senior living into a value-based reimbursement ecosystem; MA insurer UCare is an investor in Lifespark, which is in risk-based contracts with a variety of insurance companies. And Lifespark is building a technology platform with the intention of delivering more individualized and preventive services. Thomas spoke about how limited electronic medical records currently are in helping senior living providers in this endeavor. 

“That’s like looking through a little pinhole and trying to see the person through these just tiny jibs and jabs of information about their isolated interactions with the health care system, and you’re supposed to understand somebody now,” he said. “So what we’ve done is that we create an entire sphere of information … that includes lots of different sources of information about them, so that we can then be more accurate in predicting in advance potential changes in their condition.”

Katzmann agreed that a “whole new product” is needed to bring together information and create a “longitudinal, lifelong picture of an individual.”

While more individualized wellness is needed to achieve value-based reimbursement success, Mather’s Leary spoke about how this approach also is necessary to attract future consumers — the generation born soon after the Civil War might not have been focused on wellness, but today’s customer is focused on wellness and tomorrow’s customer will be to an even greater extent.

Mather last year rolled out a new “person-centered wellness framework,” and this more personalized approach has already resonated with consumers, Leary said.

“I remember when we rolled out the six dimensional model of wellness at Mather, many years ago, residents weren’t having it. They didn’t want us to tell them what they should be focusing on,” she said. “When we implemented the person-centric wellness model, they got it immediately and they have fully embraced it.”

Perhaps even more exciting, the new approach to wellness has informed Mather’s plans for a $500 million life plan community under construction near Washington, D.C. — and that project is 80% presold, with two-thirds of depositors being baby boomers or Gen Xers, and one-third from diverse demographic backgrounds, Leary said in her keynote talk.

The idea that a fresh approach to wellness is helping to attract the next generation to senior living also was reinforced by Buckner Retirement Services Director of Operations Chuck Childress. Younger residents are moving into Buckner’s recently opened Ventana community in Dallas, where the average age is around 75, he said. Ventana features a variety of personalized wellness programs, including through a partnership with preventive medicine and aerobic exercise pioneer the Cooper Institute.

“I see them as a bellwether of what’s to come,” Childress said of Ventana’s younger residents. “ … They’re very inquisitive, very interested in how can I prevent health decline, how can I maintain my quality of life.”

There was palpable excitement at the conference about the future of wellness in senior living, but also a recognition of how much work lies ahead. Providing more individualized programming requires better, more efficient ways of learning what residents want and need today, and what they will desire in the future.

“I sometimes see the lifestyle/wellness section of our resident satisfaction surveys leaves something to be desired in terms of how actionable those are,” said Tony Galvan, AVP of Living Well at Vi. “So maybe it’s a matter of just literally asking on those types of surveys, are you getting a return on your living experience here because of your participation in what we call wellness?”

Even getting clearer information from residents is insufficient, because they sometimes resist change that they later embrace, Asbury’s Leidig pointed out. When the provider took out a cafe to install a rock-climbing wall and boxing ring, “we were the devil,” he said. But today, Asbury’s oldest rock climber is 96 and this wellness offering has had a big positive impact throughout the organization.

Bill Thomas echoed this point, noting that Lifespark is introducing innovative wellness-related activities such as remote-controlled forklift racing — but residents frequently say “I can’t” when offered the chance to participate.

“I would suggest to you that to the degree your organization moves more people from ‘I can’t’ to ‘I can,’ the more wellness they’ll experience,” he said.

New staffing, marketing models

Among the biggest challenges facing operators in this new wellness era is staffing; while recruitment and retention have never been more difficult, the pursuit of individualized wellness almost surely will require dedicated and well-trained staff in new positions.

Pathway currently works with a value-based provider that involves a health coach, and Moore “guarantees” that this position will become ubiquitous in this new era of senior living. Katzmann’s vision also includes a lifestyle coach who can help devise individualized lifestyle prescriptions and help residents pursue them. And Mather also sees the wellness coach as a key player, and has a person-centric wellness coaching program developed with Wake Forest and Virginia Tech. The nine-week training program is inexpensive and open to all providers, Leary said.

Beyond a wellness or lifestyle coach, this new era requires that the entire senior living workforce is educated about wellness and sees how their own roles contribute to wellness. That’s because every component of senior living — from housekeeping to culinary — affects the wellbeing of residents in some form or fashion.

“We literally consider every single thing that we do wellness … and so for us, we really consider every single one of our staff members, a part of our wellness team,” Priority Life Care’s Byers said.

Unrelated to SHN’s wellness event, the International Council on Active Aging last week released its “State of the Wellness Industry 2022” report. This report also highlights the work to be done in elevating and supporting wellness-focused staff in senior living communities.

Only 39% of senior living and care providers surveyed said that wellness program staff are being hired, and only 34% said that wellness staff are being given technology to help their jobs. And 54% of senior living respondents said that they have not been told about career paths in wellness.

“One area of career development that will benefit the workforce as well as the organization is consistent, meaningful communication between senior leadership and all staff members,” the report stated. “ … The number of respondents who were unaware of the organization’s culture, priorities, wellness budgets and plans is an indication that lines of communication need to be improved.”

I believe such communication can be improved by the addition of more corporate-level wellness leadership roles, such as the position that Galvan has at Vi. I anticipate that Galvan will have more peers with similar job titles and responsibilities in the coming years. He sees his job mainly as supporting wellness efforts that originate at the community level and are focused on the wants and needs of those particular resident populations.

While Galvan stresses the “grassroots” nature of wellness initiatives, I think corporate leadership is especially important in systematizing and standardizing wellness approaches across multi-community portfolios. It’s an approach that Vi has taken with its Living Well framework, and an effort that Asbury recently undertook.

“We had a lot of executive directors and wellness program leaders go out and do a lot of different ideas on their own, so we didn’t have a system approach — and when you have nine communities, there’s a lot of opportunity to engage some system,” Leidig said.

Asbury recently formed a group across its system that is “responsible for our wellness moving forward,” including leveraging best practices and maximizing technology solutions across the whole portfolio.

Having a more systematized wellness approach also enables a provider to brand and market wellness more effectively. Several providers represented at the wellness event have branded wellness programs, including Vi’s Living Well and Mather’s ContinuWell.

Being able to market these wellness offerings is critical in reaching consumers and is an area where providers too often fall short, Priority Life Care’s Byers said.

As an example, she pointed out that senior living culinary programs often feature high-impact ingredients for physical and cognitive wellness, but providers don’t consistently explain the “why” behind their offerings — namely, that “we’re doing this because there is a wellness benefit to it.”

“I just think that that’s one area where we could just maybe take some credit for what we are already doing,” she said.

Becoming market leaders

I came away from WELLNESS/DISHED encouraged by the many wellness-related initiatives being pursued by providers and the commonalities across different organizations. And attendees expressed similar sentiments.

“Coming to this conference has been very affirming for me, because I think every speaker has talked about an individualized approach,” Leary said.

But it’s also clear that we’re in the early stages of the new wellness era in senior living. And while participants in our conference are moving boldly into this wellness-driven future, not every senior living provider is doing so.

Of 242 respondents to the ICAA survey, 61% said that their senior living communities will be based on a “wellness lifestyle with care options” rather than “care with wellness offerings” by 2025. That is a slight uptick from the last survey, in 2018.

While 61% is a clear majority, it’s surprising to me that the percentage isn’t even higher, given all the trends highlighted at WELLNESS/DISHED.

But this could be a motivating finding for providers — those that embrace the shift to a new wellness paradigm today and begin to act on the ideas shared at events like WELLNESS/DISHED have an opportunity to get out ahead of the competition and shine particularly brightly in their markets in the years ahead.