Salmon Health and Retirement has in recent years pivoted to hospitality to reach a new generation of older adults – but the company’s CEO, Matt Salmon, is not discounting the appeal of having a continuum of care, either.
Today the company has a full continuum of senior care that spans independent living, assisted living and skilled nursing to home health, private-duty hospice and even childcare. The Milford, Massachusetts-based operator reaches about 1,000 older adults in its communities and another 1,000 in the surrounding area.
Salmon Health has over the years built out the continuum of care with the notion that serving older adults where they are can help keep them there for longer. And looking ahead, that will remain part of the company’s value proposition to residents even as it ventures deeper into hospitality-forward services.
“Whether it is providing additional support for people … to keep them in an independent living situation longer, or someone in assisted living … layering on services in our buildings, that helps promote independence and a little bit more longevity in each setting,” Salmon said this week during a panel discussion at the Aging Media Continuum event in Washington, D.C.
The panel discussion also included Susan Ponder-Stansel, CEO of Alivia Care and John Kunysz, President and CEO of Intrepid USA.
Salmon (center) with Susan Ponder-Stansel (left) and John Kunysz / Merz Photography for Aging Media‘Water grinding away the stone’
Salmon health has been on the move in recent years building out a care continuum to reach the next generation of older adults.
For example, in 2022, the company launched a new home care venture aimed at “extending” the company’s continuum of care into older adults’ homes through flexible private-care services.
Salmon also is catering to a shift occurring in senior living with a concept called Enhanced Care Neighborhoods, where residents living in private apartments can receive services such as around-the-clock emergency response, medication administration, support with some ADLs and certain kinds of clinical care.
But the company’s strategy of catering to multiple points along the continuum did not immediately come into existence overnight. Instead, the 70-year-old company’s journey was a long “evolution” marked by slow and steady progress.
“It’s water grinding away the stone rather than trying to figure out where to get the capital and the staff for a significant expansion,” Salmon said.
Salmon said that he had arrived at the conclusion that a full-continuum approach is best after pondering “this mentality that we were going to be somehow of value to the hospital system in cutting our perspective.”
“The same healthcare issues that we talked about in 1990, we’re talking about today,” he said. “It was the segmentation, the silos, the inefficiencies, that we’ve really turned our focus away from what we can do in terms of adding value into that part of the healthcare system, to looking at the value that we can provide for the residents that reside under our roofs.”
Staffing challenges, conversations with partners
Like many senior living operators in 2023, Salmon has grappled with finding and retaining enough workers to keep things running smoothly.
That is an especially difficult task for a company focused on so many different parts of the continuum, Salmon said. In Worcester, Massachusetts, near where the operator is based, the unemployment rate is hovering just below 2%. That is complicated by the fact that Salmon Health is pulling from the same “finite workforce” that other operators in the area are.
“It scares me to death where we’re headed,” he said. “You’re trying to grow a business that relies entirely on staff – that is becoming a huge challenge.”
He added: “Finding people who want to work, finding people who have a skill set – whether that is a personal care home health assistant, or even an LPN or an RN – that is the biggest restriction that we have. As a society, we want to start pushing all of this health care to individualize it in your own home. But we don’t have the people to provide that care.”
In 2019, Salmon said he convinced the other business stakeholders in his family to significantly pare down its exposure to skilled nursing. The company ultimately reduced its skilled nursing footprint by about half, and recruited those former SNF workers to work in the company’s home health, hospice and private-duty businesses.
“But those nursing home residents still need care too, and so we’re just robbing Peter to pay Paul,” he added. “On the homecare-based side of our business, we actually pay more than we do on the housing side.”
He added “I’d double the size of the business if I could, but I’d be limited by staff.”
Another challenge for Salmon Health is how to frame all of this to its ownership and capital. Today, the company works with REITs, banks and private equity partners, and describing how all of the pieces fit together can be a challenge.
“In an assisted living, for example, you start using your home health and private duty in that assisted living to provide the care … rather than having the care being provided by your own [personal care aides], private equity investors are going to say, ‘Well, where’s all that revenue gone?’” Salmon said. “So, we’ve run into some challenges explaining to our capital partners how the whole continuum works and how it fits together, and why that’s the value proposition that our organization presents.”
But at the end of the day, Salmon stressed these challenges are well worth navigating given the prize for operators that can effectively manage a continuum of care. Looking ahead to 2024, Salmon said the company is “trying to be aggressive and in preparing to be smart about home health growth.”
“If you’re focusing on the care experience for the people that you serve, there’s tremendous opportunity,” he said.
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