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The senior living sector was rocked this week by the Washington Post’s series slamming assisted living.
The three articles took aim at multiple facets of the senior living business but mainly focused on elopements among residents with memory care needs. Senior living associations and some of the companies mentioned in the articles were quick to protest several elements of the reporting, and there are certainly many legitimate points to make in defense of owners and operators. And I understand the urgency in mounting such defenses, given the stakes involved from a consumer perception and public policy perspective.
But I also think that professionals in the sector can and must glean lessons from the Post’s series, which reported on heartbreaking and unnecessary resident deaths, and should consider the articles not just from a posture of self-defense but self-reflection and strategic thinking — specifically with regard to the future of memory care.
In this week’s exclusive, members-only SHN+ Update, I offer analysis of the Post’s series and key takeaways, including:
- Implications of the fact that nearly every assisted living community is becoming a memory care community
- The imperative to think bigger about staff training practices
- Why “dumb tech” is one of the most insidious villains in the Washington Post’s series
- Why the industry’s weakness in telling its positive stories is becoming inexcusable
Every community a memory care community
During a lunch for SHN+ members at our BRAIN conference last year, an operator CEO pointed out that memory care needs have become so prevalent, every assisted living community is now essentially a memory care community.
I was reminded of this comment when reading the Post’s series, which reported that people with memory care needs now account for “almost half of all residents in assisted living.”
Senior living providers are well aware of how common memory-related diagnoses are within their populations, and many have been pioneers in elevating care for people with Alzheimer’s and other conditions affecting the brain — a fact that the Post’s articles did not highlight, but that industry advocates emphasized in comments emailed to me this week.
“Assisted living providers are consistently adapting to the ever-changing needs of their residents, especially those living with dementia. There is unprecedented focus around life-enrichment programs, non-pharmacological interventions, consistent staff assignment, and facility design,” the National Center for Assisted Living (NCAL) stated.
Argentum President and CEO James Balda made a similar point, writing:
“Senior living providers have been extremely proactive in preparing for the future of residents with memory care needs. Most providers are exploring and implementing the latest in care and technology innovations that promote safety, balanced with the highest quality of life for residents with memory impairment.”
So, there is much for the industry to be proud of and build on — but I also believe that the sector as a whole needs to dedicate still more attention and resources to memory care, particularly given the increasing prevalence of dementia in buildings that serve a more general population. Providers risk putting residents’ safety and their own businesses in jeopardy if they are too slow to appreciate needs in this area and do not equip their staff with the necessary skills and tools related to dementia care.
We launched our BRAIN conference a few years ago in part because we recognized that memory care too often is overlooked or given scant attention at the major industry conferences. And in truth, Senior Housing News historically has treated memory care in much the same way. We’ve typically written a few stories focused on memory care each quarter, but approached the topic as a relatively specialized niche. Now, we’re making a concerted effort to report on memory care in a much more routine and comprehensive way, via our weekly Memory Care Business newsletter.
We’re early on in our effort to expand our memory care coverage, but I’m proud that we’re making this push. I hope that the sector as a whole ratchets up efforts to drive memory care innovation and share breakthroughs and best practices on the biggest stages on a regular basis. Informed by the Post’s series, there are three areas that stand out to me as areas of focus for the future of memory care and the sector as a whole: staff training; next-generation technology; and better storytelling about senior living’s value proposition.
Thinking big on staff training
The Washington Post identified a few requirements that “advocates” have proposed to “improve safety and transparency” across assisted living. One of these requirements would be a mandate that all caregivers receive at least six hours of training on dementia.
“We encourage specialized dementia care training, but each community should determine how much training is necessary based on their specific resident population,” NCAL told me via email. “It’s also important to focus on the content of the training rather than an arbitrary number of hours.”
LeadingAge President and CEO Katie Smith Sloan also put the focus on content rather than quantity, when I asked about the organization’s position on mandated dementia training. She wrote:
“On the question of mandating dementia training, the questions to consider are content (i.e., which program) and how will any requirement be implemented and regulated?”
She also pointed to several training-related resources that LeadingAge makes available to members, and caregiver training programs implemented by organizations such as Goodwin Living and Beatitudes.
I agree with NCAL and Smith Sloan that mandating a set number of training hours is not the most effective way to ensure care quality. However, I do think that the industry can do a better job of coming together to create standards.
The industry’s frequently stated position is that every provider organization should decide individually how to approach care and achieve high-quality outcomes, including what type and amount of staff training is required. As NCAL put it to me this week:
“We encourage specialized dementia care training, but each community should determine how much training is necessary based on their specific resident population … If you’ve met one individual living with dementia, you’ve met one. Blanket, one-size-fits-all standards are neither appropriate nor effective.”
This is true, or at least seems reasonable to me. But as a response to this issue of dementia training, I think that the sector has an opportunity and even an imperative to take a bolder approach.
The fact is that more than 9 million Americans could have dementia by 2030, and that number could reach 12 million by 2040, according to calculations published in The Journals of Gerontology. Senior living providers will be forced to bolster dementia training for their caregivers as memory care needs increase in their buildings, and the nation as a whole is going to have to learn how to become a more dementia-friendly society.
Rather than combating or resisting uniform standards, I would love to see the senior living sector take a more vocal and visible leadership role on this issue. Perhaps industry associations could create generally accepted dementia-training frameworks for providers and undertake a sector-wide push for adoption of these standards, similar to the efforts that nursing homes have made to reduce the unnecessary use of antipsychotic medications.
At the same time, providers could prioritize working with organizations such as Dementia Friendly America to extend training to the broader community, with the message that everyone should know some basic facts and best practices for interacting with people who have dementia, just as everyone should know CPR.
I understand this might seem like a pie-in-the-sky vision, given the reality of staffing shortages and other pressures facing providers, the complexities involved in creating a generally accepted framework for dementia-specific training, and other practical considerations.
However, based on the comments shared with me this week, I do think there is agreement among the industry associations that dementia-specific training is needed across the sector. As Balda put it: “Argentum strongly advocates for dementia-specific training for all senior living employees and additional specialized training for workers directly caring for those with memory impairment.”
I do not think it is such a leap to go from “strong advocacy” to a more organized push for training standards.
And fundamentally, I believe that the sector needs to consider how to create frameworks that balance flexibility with standardization, so that best practices can be widely adopted, easily advertised to consumers, leveraged to evaluate and “name-and-shame” subpar owners and operators, and perhaps forestall certain governmental regulation.
Smarter tech
“Dumb tech” is one of the most insidious villains in the Washington Post’s series.
The articles are full of references to staff members who ignored alarms and alerts. I do not mean to let negligent workers off the hook and scapegoat technology, but I do want to point out that there are some obvious technological shortcomings that are making it more difficult for senior living caregivers to do their jobs.
For example, the Post reported on workers at a Pennsylvania facility who told regulators that they “often ignored door alarms” because they assumed “they were caused by employees entering the building.”
The Post series lambasted the low pay that senior living staff earn and laid the blame largely on ownership groups, claiming they underinvest in staff to maximize profits. But without explicitly making this point, the series also painted a portrait of an industry that has chronically underinvested in technology, with the result being that in an age of smart tech, providers are still working with dumb tech – systems that apparently can’t tell the difference between an employee walking into the building and a resident eloping.
Take this statistic from the Post’s reporting: “In cases where a cause of death could be determined, The Post found that 61 percent [of residents who eloped] died after exposure to extreme heat or cold.”
This left me wondering: How difficult is it to utilize wearable technology that monitors temperature and generates a specific (and urgent) alert to caregivers if a resident’s body temperature, or the temperature of the surrounding air, spikes or plunges?
I assume that such technology already is available. But I hope that the Post’s series inspires tech entrepreneurs to address some of the issues described in the piece in even more novel and effective ways. And the series also should serve as just the latest wake-up call to the sector that investing in technology must be a higher priority, and that the costs of not doing so are far greater than the dollars-and-cents required to increase tech budgets.
Telling the human stories of senior living
The senior living industry has put forward some statistics to contextualize the Post’s reporting and defend the sector’s performance. Argentum President and CEO James Balda noted that he has concerns with the validity of the Post’s data generally, and he wrote:
“Even taking [the Post data] at face value, fatalities due to wandering are 0.0015% of the more than 6.2 million assisted living residents served in the last five years.”
And he cited statistics from J.D. Power surveys as proof of how popular senior living is among most residents.
These stats do help make the case that the Post’s reporting creates a misleading picture of senior living and the prevalence of elopement-related deaths. Yet, I wonder how effective it is to marshal statistics as a response to pieces like those that ran in the Post.
My doubt comes from the fact that the power of the Post’s series – at least in my opinion – came less from the statistics involved and more from the articles’ focus on individual stories. The vivid details and even video shared with readers conveyed the horrors that older adults and their families endure when fatal elopements do occur, and I think resonate more powerfully with readers than numbers do.
I think that the Post certainly recognizes the power of this type of storytelling and sees its journalistic mandate as humanizing victims that otherwise might be mere statistics – and this is a noble mandate, I would argue. In fact, the story headlined “Dozens of Assisted Living Residents Died After Wandering Away Unnoticed” concludes by listing the names of those residents and linking to obituaries and other biographical information.
One takeaway that I see here is that the senior living industry must do a better job of telling its positive stories on a regular basis. Despite the findings of J.D. Power, the fact is that consumer perceptions of senior living remain negative. That’s been shown again and again by surveys, with one of the most recent coming from Age of Majority and the International Council on Active Aging.
More pieces like the Post’s are inevitable in the years ahead, and if the industry has a stronger, better story to tell about its offerings and care quality, it must do so day-in and day-out, including by improving how communities are marketed and advertised and expanding the ways that senior living providers integrate themselves positively into communities.
This is hardly a novel idea. “As an industry, we’ve done a pathetically poor job of telling our story,” Dan Hutson, currently the head of marketing at Priya Living, said at an event we hosted in 2018. The next year, we ran the story “Grocery Chain Publix Tells Great Stories About Its Workers. Senior Living Can Do Better.” Our story archives are full of stories with similar messages.
In fact, none of the issues I’ve raised here – whether lack of compelling storytelling, underinvestment in tech, or a lackluster approach to creating industry standards – is new. Some amount of negative press is bound to occur, but unless the industry addresses issues that are persistent and generally recognized as problematic, the cycle of bad headlines will become more brutal, and deservedly so.
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