Insight Living is building a new make and model of the senior living “bus” while driving it down the highway.
That’s an analogy Principal Bryan Ziebart uses to highlight the daunting road ahead for senior living providers. On the one hand, operators will need to continue to drive operations and gain occupancy and elongate margins in the year ahead. On the other hand, they must also prepare for an influx of demand that will require a new way of doing business.
At the heart of Ziebart’s vision for a more data-driven future is transparency with families and using data to build in more efficiencies. And Ziebart believes that data can fill “that gap and about 100 others.” That’s possible through a joint venture with business intelligence firm Smilefish to aggregate and build software tools to aid staff and resident families with visions of a data ecosystem supported by artificial intelligence (AI).
“We’re thinking of data in a really transformative way that we can support what I call our three customers: Our employees, our resident families and our residents,” Ziebart said during a recent episode of the Transform podcast.
“Our integrated AI platform that we’re building is really the core for how we’ll operate our communities in the future and it really adds the most benefit to communities that have a very high expense run rate in labor as well as utility utilization and long-term driving into some of our insurance costs,” Ziebart added.
Since standing up the Ativo Senior Living brand in partnership with Link Senior Development, Insight Living has two communities under its banner in Prescott, Arizona and a project under construction in Albuquerque, New Mexico.
That will be followed by “a couple other” projects in the coming months. Also, the new growth could be layered with acquisition or joint venture opportunities as they arise outside of the Ativo brand, Ziebart said. That future cadence of new development could look like breaking ground on “one or two projects annually.
“I think we’re positioned well for the next turn of the page,” Ziebart added.
Highlights from Ziebart’s podcast appearance are included below, edited for length and clarity. You can listen to Transform on Soundcloud and Apple Podcasts.
On Insight Living’s 2023 campaign:
I kind of use this analogy all the time with our team. We’re driving the bus while we’re wanting to build a new one. So it’s been a lot of that this year, we have several great communities, one just opened and others that were focused on driving value. So we need to continue to drive the bus, but we’re also every day being mindful of the fact we’re trying to build a new bus that doesn’t exist, and create a new operating model that doesn’t exist within senior housing today. So it’s been a balance, but it’s a challenge worth pursuing. That’s been our year essentially.
On creating a new operating model:
I think what I tell people is that we are a data first operator. So I think within that continuum of data, there’s very low analytical maturity, where there’s reports and dashboards. Those are all very valuable management tools. But we are thinking of data in a really transformative view, and not through incremental change, but data to really drive a new way that we can support what I call our three customers: Our employees, our resident families, and our residents. When our families only get phone calls from senior living operators nationally, when something bad happens, there’s a gap. We believe that data can help fill that gap, and about 100 others.
Expanding on the launch of the Ativo brand:
We have a couple communities under the Ativo brand. One was a new build we just opened in Prescott, Arizona. We have another construction project underway in Albuquerque, and a couple others that will follow over the next few months. And so Ativo is really the the subset of our communities that our sister company Link Senior Development, we capitalize internally, and we manage internally.So those are really our kind of Class A projects that we build, obviously, We also pursue other acquisition opportunities and, and other joint ventures that may fall outside of that brand. But I think a TiVo will really be kind of that, that set of properties front center for us.
Geographically, we’re really focused on the west and southwest. I’ve got a couple of young kids at home and so being able to take a long, long day trips to our properties is important for me, but, beyond that, I think we’re very low ego, so I don’t feel like we need to be in Scottsdale or Newport Beach necessarily for the sake of it. Again, most of our deals are capitalized internally. So it’s important for us that we are very mindful of pursuing projects that we believe have the greatest chance of success. Every dollar is our own and we treat our internal and external capital the same with that regard. But we’ll look for opportunities wherever we live.
I think our integrated AI platform that we’re building again, that’s really the core for how we’ll operate our communities in the future. It really adds the most benefit to communities that have a very high expense run rate in labor, as well as utility utilization. And long term, I think even driving into some of our insurance costs. So this really lends itself to our best markets being markets that have inherently higher cost of operating because I think we can really move the needle on the cost side based on what we’ve seen so far.
On charting Insight Living’s growth:
Number one is that we constantly have discussions with other asset owners who feel exactly what we felt prior to starting insight, which is that disconnect that the industry discussed at length on this disconnect between owners and operators. We’ve been sowing a lot of seeds in really meaningful discussions over the last several months with several owners who feel this and, as we pursue growth for Insight. We believe that we’re going to lead with an example that really puts our money where our mouth is, so to speak, and in backing up what we believe for our properties. And so with that between breaking ground on one or two projects per year, pursuing acquisitions strategically, and then pursuing really strategic joint venture management, not just simply third party, I think we’re positioned well, for the next turn of the page.
Challenges on staffing:
Certainly, there’s a lot more predictability around wages. Also, in general, we’re seeing about an 80% increase in applications over the last year for a lot of our line level roles, we still are in some smaller markets that run pretty thin on the depth of the labor pool. So that’s something we’re always cognizant of. But one thing that I think is the confidence level in our non labor expense projections. Again, six months ago, a year ago, obviously, everyone’s focused, rightfully so on, on labor as a bogey. But we’ve seen dramatic increases in many non labor categories as well that add up significantly.
So Living Path is a third-party industry resource that now publishes great data around regional wages and wage analysis. So I think there’s a lot of companies bubbling up on the periphery, like Living Path that can really help educate operators to be more informed about the wage side. What we’ve also done is we’ve really begun to broaden the scope of who we’re hiring in the job descriptions and focus more on hiring for a set of values and competencies more than a certain set of experiences.
On Insight Living’s data model:
Every senior living community has an average of 13 different tools that are used to operate a community and many of these are individual point solutions that solve a specific problem. And so the progression of this has been, let’s say, 20 years ago, all of these problems were paper driven and manually addressed. Fast forward 20 years so where are we today? Now, there’s all these different technology companies that have a specific solution for each of these problems. I think that’s where a lot of operators are today is that they feel they’ve solved some of these problems because they have an in-place solution. Of course, each of those does not integrate with the other and also each of those costs several $100, or sometimes 1000s of dollars per month each, because they have an entire business they’re building around these different aspects.
So what we’ve actually done is we created a layer that sits above the communities. It ingests all of the data that every single tool we use spits out. It doesn’t just pull in the information from these tools, but it’s also pushing into the tools, information around our residents and units to help normalize it. So we have one consolidated database with millions of records that are all seamlessly tied together. It allows us to really unlock a whole new paradigm around what do we want to have happen when someone visits a specific resident? How is that influential? What do we want to have happen when a resident skips a meal, and also is prescribed a new medication that makes them feel nauseous. So we can pull the thread and all these individual use cases, and really begin to unlock some meaningful insights. Now, that’s kind of the first step: delivering, taking the data, organizing it in a way that makes people say, ‘Oh, that’s really interesting, right?’ At a high level, that’s really it. And I think we’ve really, actually begun to insource. A lot of these are point solutions, and we began to create our own proprietary set of tools that our committees operate off of to address gaps in the existing tools in the market to really fit the actual need of the business. And so it’s been very good, I think we have delivered a lot of ‘wow, that’s really cool.’ moments and we’re at that turn of the page to say, ‘Okay, how do we make this meaningful in terms of driving family engagement in terms of driving better outcomes for residents for an overall better product.’ So we’re excited about the next year in this space.
On achieving data integration to drive insights:
it’s paramount to your point. Every tool provider wants to be the integrator. They want you to use their platform for reporting their platform for X, Y, and Z. I think for most companies, they may have to do that because they don’t have this as a core competency. That is totally fine. That’s going to add an incredible amount of value for senior living overall. And I think there’s a lot of great technology companies that will serve that role. We believe that that integration of the data is critical to unlocking the next iteration of senior housing. We have a tight relationship, a joint venture formally with a data science company called Smilefish out of Newport Beach in California and Smilefish, they’re experts in healthcare applications and data integration. On one side, we have experts in driving innovation and data and machine learning and integration.
On the other side, within Iinsight we have a group of folks who understand the application of data to business and understand the practical challenges and realities of implementing technology and tools into communities that are operating. And so that relationship is completely symbiotic and we are constantly iterating on how we can improve and make the data more useful and meaningful. And so I think whatever operators can do it’s really driving that integration and automation is going to, it’s going to pay 10x returns on the time spent on that.
On key data points informing operations in senior living:
As of a month ago, it’s about 27,000 unique records per resident for our pilot communities that we’re running this with. So that’s a lot of information overall. It’s useless as a big lake of millions of records, but what we’ve done as kind of our quick, early wins this year is, when certain things happen within the data, it triggers surveys via text message, or email or phone call automatically to resident families, which has been very useful.
We have a firm belief that there needs to be far more engagement with resonant families. Up until the point where we we have language models like Chat GPT, and integrated data, it’s impossible to have that level of engagement with families, because we can’t have caregivers on the phone 24 hours a day calling families, but we’ve begun to really have this conversation with families based on their visits based on the care of their loved one based on after they’ve moved in. We’ve been able to really build the foundation for families and we want you to be a part of this discussion. We’ve also built internal tools that allow our team, our caregivers, and our executive directors and our pilot communities to be able to have a conversation with the data directly. You can ask it,, “How was Austin’s week, and the system will come through the 27,000 records for that resident will return to our team internally, how that residents week was pulling from they had a great week, they slept well, that their vitals were unchanged, they took all their medications, and provide a narrative based summary to our team, so we’re able to pull that only because all of the data is integrated. At some point, it’s going to be paramount for us to begin to have families tap into these capabilities. Because I only get a call from the memory care that my grandpa’s 1,000 miles away when something bad happens. And we think that that is an industry problem preventing more adoption of the product. This is a vastly improved product, because it feels very blackbox-ish. It feels very much like there’s no communication from the consumer’s perspective. And, and again, we’ve already begun to break those barriers down, and we’re excited for that.
There’s a direct, quantifiable difference between living at home alone and living in a community with these capabilities. So we are building again, we not just are aggregating the data, but we’re building out our own set of IT to help us understand what’s going on everywhere within the communities at all times. I think there’s great third party products that exist out there, but that solves one problem. I want to be able to pair the observations from our technology, our sensors into a lot of other data to really drive to these consolidated findings, and I think we’ll actually be able to predict decline.I think we believe that there’s, again, what we’ve seen so far clear leading indicators for decline, cognitive decline, physical decline, and social emotional decline. So by packaging the information together in this consumable format, I think we’re going to be able to predict a lot of these issues longerm.
On informing staff with actionable data:
That is the actual challenge. It’s much harder, making data actionable than it is to do everything else we just talked about that we’ve been working on for a year on, I think that’s like the easy part, right, aggregating it, and putting it all together and getting a lot of wow, that’s cool. That is an important first step. So I think there’s two pieces to this. One is that we have we just recently on boarded a director of customer experiences, that is the role you typically wouldn’t have somebody who is non-operational, whose sole job is to focus on how do we use all of this capability, all of this information, to rework every piece of our business from the lens of our customers, whether that is our residents, their families, and our team members to utilize the data.
I think a lot of that is around automation. So if X happens in this system, then Y happens in this other system. If our moisture detection sensor that’s in every comm room detects moisture, it automatically creates a ticket for our maintenance guy to go out in our own system that we use. If there’s water detected on the ground outside of a residence shower, then it creates a ticket to housekeeping to go make sure that there’s not a slip hazard. If a resident goes to the bathroom 1.2 times per night, normally, and then they go to the bathroom 3.5 times over the two nights, then it triggers an alert to our caregivers or our executive director or the family member, depending on power of attorney, that there may be a problem.
So I think triggers within the data to automate those engagements are really what will make operations life a lot easier because it has to be actionable and has to be concise. That’s definitely the biggest challenge. Their language models also helped us because we can send a finding to someone, it could be a team member, it can be a family member. If a resident and their family members are at a doctor’s appointment, or in the future our family members can text a number, go on to a portal and be able to get all the historical information that we’re gathering to help the primary care physicians be more informed and educated. It’s just really thinking through how to make each piece of the data as useful as possible and that’s really our aim overall.
On Insight Living’s planned genetic model to further personalize care:
What I like to do with all these things because it feels very theoretical, is to start with the ‘Wouldn’t it be cool if we had if each resident had their own custom menu?’ They sit down and they have their own menu. And that menu has dining options that are curated to their own individual biology. This is like you think you think big for us, right? Their own biology, their own allergies, their own sensitivities to gluten, or eggs, or whatever it may be that’s causing them that joint pain or that heart palpitations because of certain spices, whatever it may be. So it improves all of these things, but it’s operationally and logistically a nightmare, right? Then we work backward from there to think through well, what’s the very first thing we could do to at least get one step closer to that? And so what I think we’re doing now is, we believe that between biometrics and bloodwork and even genetic predisposition thing.
We cannot just use question and answer surveys for our onboarding of our residents, but use that level of data which then gets into really a big data discussion, to drive that discussion. So giving the resident that information, so they can make that decision consciously, but I think those are like the first couple steps. Then there’s a bunch of steps in the middle and then you get to a point where you have care plans, and you have dining and activity programming and everything curated around each resident’s needs individually, and it adds no additional burden to the community operationally.
If it’s done really thoughtfully, and using the data to enable automation. Another quick example, I know we’re short on time is I was at a med tech conference medical technology conference in Orange County, and a vendor had used a single photo so they could do a biometric scan and replace a 20 minute process to do a posture analysis. A degraded posture is associated, like with grip strength and gait to fall risk and even cognitive decline. So it would be great if every day we could take someone’s posture, but it would take 20 minutes a day for 100 residents clearly would not be operationally feasible.
But this new technology which they haven’t even thought about applying and senior housing exists, and our system can send a still shot from commentary cameras to this application. And every day return someone’s posture score just ambiently living in our communities. Wouldn’t it be cool if we can identify a degradation of posture earlier and get PT involved and get in course correct before a fall happens and they have bone density challenges, and then they get assigned PT and OT.
We believe we can truncate that because only technology is emerging now. When it’s integrated, we can see [a resident’s] posture has been declining the last couple of weeks pretty notably. And also his diet has been changing, and his sleep quality has been changing and you know what, three weeks ago he was on this new medication that has had certain side effects. No human is doing that analysis, right. That’s all our AI platform that’s delivering that to your loved ones and saying, We think this is a risk. This is a red flag here. We need to get the primary care physician engaged to course correct before again the inevitable happens.
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