Tech Use Among Seniors

The session opened with a general overview of technology usage research conducted by Pew Research Center. Included in this research were several standout statistics. As of 2016, Pew reported that smartphone adoption among surveyed seniors (people aged 65+) had nearly quadrupled from 11% to 42%; the panel echoed that the technology-adoption trend has only continued. Pew also notes affluent and better educated seniors are more likely to report smartphone ownership. However, despite the trends towards technology use amongst seniors, the Pew research points out that technology use was significantly lower amongst seniors aged 75+ compared to their younger counterparts. Transitioning from the use of technology among prospective senior living residents, the panel moved to discussions of the role of technology within senior living organizations.

Organizational Technological Infrastructure

To frame the discussion of organizational technology adoption, Nick Patel used a “Technology Maturity Model” pyramid to represent organizations’ level of technological maturity and adoption. His analysis showed that the fundamental aspect of technology adoption is a solid foundational network and data infrastructure. He defined this as the internet and data sharing networks that allow for layering of more complex data collection and distribution. For example, without reliable and accessible internet, investment in complex resident tracking software is ineffective. For most organizations, the climb to the top of this pyramid can take three to five years. 

Shaun Smith noted that the pyramid prototype is the useful to his organization. In relation to Asbury, the organization was able to head off some of the technology stress of the Pandemic to buttress Albright’s technology infrastructure. Nick echoed this sentiment. Organizations which had already begun scaling the pyramid were more prepared to pivot at the onset of the Pandemic.

However, sometimes there are still unforeseen  technological challenges. When Asbury staff needed to reach its LIFE Center participants (Pennsylvania’s PACE program) at the onset of the Pandemic, they quickly realized those seniors were largely without access to broadband internet or smart technology. Pivoting, the team at Asbury canvassed door-to-door with iPads. Though it was originally a challenge, the processes they developed are now used to more quickly onboard new residents. 

Integration of Technology

An important theme that emerged during the discussion was the human component of technology. AJ Peterson, as a technology solution provider, discussed how their goal is to craft platforms integrating all of the  technology tools into the workflow. He highlighted the importance of obtaining feedback from the end user throughout the process of developing a tool. If tools are easier to navigate, and fit the working needs of those using them, they are more likely to be adopted widely. Shaun echoed these sentiments, saying they have found that technology must be human-oriented. Adoption and integration are easier if there is a human connection element on the front-end. Residents and caregivers increasingly adopt the technology if they have human-centered training at the start. AJ also noted the ways in which these tools will continue to shift. Particularly, he discussed the role virtual care would play as part of the larger care strategy. He positioned the question: How does the entire care team engage with residents and  family members? They are anticipating growth in the remote patient monitoring space and seeing a shift that emphasizes a wellness-focused model, where risk is identified sooner and mitigated.

Emerging Technologies

The session concluded with discussion related to the emerging technologies impacting the senior space.  Whereas some tools, used to reward employees, may somewhat alleviate staffing and expense concerns, other tools, like VitalTech, Trueloo, Apple Watches, and Amazon Alexa, may allow more seniors to stay at home longer. Likewise, Mynd VR, Zoom, Mirror, and other technologies allow seniors new outlets to improve mental and physical health. The panelists all shared interest in how these new technologies would impact the aging space, but they unanimously voiced the need for careful adoption of the right tools versus chasing the newest technology.

COVID-19’s Impact on Growth Plans

Each organization noted the challenges of acquiring or affiliating with organizations during the Pandemic. However, all organizations believe there will be more acquisition opportunities in 2021, as the Pandemic begins to end. Benchmark Senior Living has seen limited acquisition opportunities throughout the Pandemic, acquiring only one CCRC in the last year. They expect to acquire more properties in the near future, as struggling communities become available for purchase.

Lifespace Communities has focused on redeveloping and/or expanding communities during the COVID Pandemic. Due to the impact of the Pandemic, they had to frequently revisit market studies and reconfigure expansions to meet the current market. Additionally, they have seen more opportunities for affiliations, especially with single-site communities that would like to be part of a strong non-profit system.

While Lifespace is not actively seeking affiliations, they typically bring in communities on a stand-alone basis. Once the community stabilizes, they then merge the community into the obligated group.

Despite the Pandemic, Voralto Senior Living is in growth mode and is actively seeking acquisitions. Voralto believes there are opportunities under all economic conditions. During the next quarter, they anticipate closing on three communities.

Where have you sought expense savings to offset the impacts of COVID-19?

To mitigate the Pandemic’s impact on census levels, senior living providers have had to find various ways to reduce expenses. Voralto has sought to lower staffing and non-resident care expenses. While Voralto has not had to lay off employees, they have seen a reduction in staffing due to a decline in census levels. To lower staffing expenses, they have focused on hiring more part-time staff, conducting cross training and sharing employees between communities. Voralto has lowered non-resident care expenses by negotiating with supply vendors and purchasing PPE in bulk.

Alexia Pozar of HJ Sims has also seen senior living providers lower expenses through reduced staffing. Additionally, she has seen cost savings in the following areas:

• Advertising: Senior living communities have reduced spending on newspaper/mail advertising and often switched to managing their own social media.
• Dining: Reduced costs have been experienced through streamlining menus and managing food waste.
• Activity/Entertainment: Due to Pandemic restrictions, activity expenses have decreased.
• Deferring Capital Improvements: If possible, communities have delayed spending funds on repair and replacement.
• Negotiating with lenders: Many communities have been able to negotiate with their banks on lower interest rates or loan forgiveness due to the Pandemic.

Low Interest Rate Environment

One of the few silver linings during the past year has been historically low interest rates. These low rates have allowed senior living communities to refinance loans, resulting in significant debt service savings. Benchmark Senior Living has benefited as actual interest rates on debt associated with its $1.8 billion portfolio recapitalization are below underwritten rates, allowing Benchmark to offset a large portion of lost revenues due to the Pandemic.

Lifespace Communities has seen its financing options increase due to low interest rates. As a non-profit senior living provider, Lifespace Communities has typically
used fixed-rate, tax-exempt bonds to finance capital improvements. Rates have reached a threshold to where typically non-viable options, such as taxable bonds, have become available. In addition, Lifespace has utilized commercial bank loans to reduce debt service, taking advantage of ultra-low bank rates.

Lessons Learned during the Pandemic

The Pandemic forced senior living providers to face  unprecedented challenges, which led organizations to  learn valuable lessons for the future. All panelists  indicated that valuable staff and team culture often  allowed their organizations to overcome the challenges  of the past year. Voralto Senior Living and Benchmark  Senior Living found that rewarding employees, either  through premium pay or other incentives, like providing  meals to staff and their families, enhanced employee  retention efforts.

Further, many of the panelists gained appreciation of the importance of technology and communication. HJ Sims’ Alexia Pozar noted that the Pandemic required organizations to be transparent and communicate effectively with their staff, residents, residents’ families and vendors/lenders in order to retain staff and residents, calm fears and negotiate new lending terms.

Lifespace Communities learned about the importance of a strong balance sheet and operational results in poor economic conditions. Lifespace had a strong balance sheet coming into 2020, which has allowed the organization to “weather the storm.” Additionally, they noted the importance of strong operational results beyond entrance fees, which are often tied to economic conditions outside the control of the senior living provider.

Lastly, Voralto and Benchmark discovered that they needed the ability to adapt in the early stages of the Pandemic to ensure the operational success of their organizations. To meet new challenges, Benchmark often had management oversee processes that were outside their normal role. Voralto found that they had to quickly to new rules and regulations, ensuring that they could continue marketing efforts and visitations. Pozar found that organizations with strong internal policies and best practices were greatest equipped to effectively adapt and face unforeseen challenges.

Resilience in Crisis/Lessons Learned

The COVID-19 Pandemic has created challenges previously unseen. Suzanne highlighted the importance of adaptability, and  maintaining the ability to pivot  quickly to rapidly changing  circumstances and state guidance. Tom shared that most communities  had disaster recovery plans in  place, including Pandemic plans, however had focused largely for  events such as hurricanes and  earthquakes, with less active  preparation for a Pandemic event.

Speaking to recovery, David said that while slow, recovery has started. Beyond the vaccines, there are positive signs. For instance, leads, tours and inquiries are increasing. Both Watermark Retirement Communities and HumanGood communities have  seen a significant uptick in web traffic. David acknowledged that recovery has been uneven across  regions, in part because of differing local rules regarding the closing of  campuses due to positive tests among residents or staff.

Staffing Changes During and After COVID

John stated that COVID exacerbated, rather than created, staffing challenges faced by senior living communities. The question facing organizations is how much of the increase in staff expenses is permanent and which will abate as the Pandemic eases. Tom added he does not expect a return to pre-COVID levels, due to the lessons around infection control, greater  customer expectations and the need to increase wages to attract and certain staff. John pointed out better wages for front-line health care staff are necessary on an industry-wide basis, otherwise recruitment will become increasingly difficult. Suzanne added increased fees were previously met with strong resistance from residents. During the past budget cycle however, as the majority of fee increases were  funding higher staff wages, Aldersgate encountered little to no resistance. Others also indicated their staff appreciation fundraising efforts yielded record results. 

Marketing/Communications

Tom discussed Benchmark’s efforts to maintain an open line of  communication with their communities, residents and families. In fact, throughout the Pandemic each community has  been sending daily communications regarding the status of COVID-19 on campus. John discussed his organization’s efforts to leverage technology, such as tablets, to advance efficiency while improving resident and team member experience. 

Social Awareness

Suzanne shared that socially distanced marches were organized  at Aldersgate, with leadership from staff, following the death of George Floyd. These occurred on and off-campus, were attended by staff and residents, and even those in the  skilled nursing facility. John  offered that their internal conversations with staff showed that while good intentions were recognized, they are not enough, that people of color and LGBTQIA+ staff are looking for actions and outcomes. Further, it  was understood that this is a  journey, and these efforts cannot be viewed as short-term programs. Suzanne added they should not be called programs, as programs  eventually terminate, and these should be permanent changes. John added that piecemeal or one-off  approaches often do more harm than good. David pointed out that Watermark was able to leverage  experienced gained through an art/training reach-out effort to the  LGBTQIA+ community, called  “Not Another Second,” to implement training around race  relations.