Tag: affordable

A guest blog post by Brian Mailliard, CFO of St. Paul’s Senior Living Community

What does a community do with a prospective resident that is nursing home-eligible, does not need 24-hour care and yet can’t live independently? Up until now, the answer in western Pennsylvania has primarily been “personal care.” Unfortunately, Pennsylvania has many older adults who primarily live off of social security. These seniors do not have the assets to pay for personal care.

The problem is especially severe in rural western Pennsylvania. Here, the main industries of farming and manufacturing have taken a hard hit over the last 20 years. To make matters worse, affordable housing options for older adults are few and far between.

The good news is that, in the last five years, an alternative housing model has appeared. Share Care houses have been opening up in western Pennsylvania. This new housing bridges the gap for those with a low asset base who need assistance with activities of daily living.

A Neighborhood Solution

For-profit and nonprofit companies have been purchasing three-bedroom ranch homes in the community outside of their traditional campuses. The companies make small renovations, such as wheelchair ramps, wider doors and accessible bathrooms, to accommodate three residents. The residents utilize the Medicaid Home and Community-based Services waiver program,  plus their social security, to cover the cost of care. Once the home has three residents, the community can typically recoup the cost of the real estate purchase, plus renovations, in a 4–5-year time frame. At this point, the model becomes profitable. Since there are not more than three residents receiving services under the same roof, this model does not fall under personal care regulations.

The waiver will pay for an individual to get up to eight hours of assistance per day in a home in the community. Housing three residents, each optioned for eight hours of care per day, under one roof allows a company to have a care partner in the home 24 hours per day, seven days per week. Staffing is provided though a company’s home and community-based service providers, which now have the ability to offer staff the set schedules that are typically offered in home care. What I have found is that, in these small homes in the community, the staff and residents become their own little family. They grow close by doing activities together, such as shopping and cooking.

New Share Care Homes Opening

St. Paul’s Senior Living Community has opened two of these Share Care houses in the last six months. Wesbury United Methodist Community in Meadville, Pennsylvania, is also involved in Share Care. In addition to providing care at its campus, Wesbury owns and operates eight Share Care homes in the Meadville area. I have toured two of these homes. I’ve also met with Wesbury’s chief financial officer to discuss the community’s successes and struggles with Share Care.

Wesbury identified the need for a level of care for lower-income individuals that are not nursing home-appropriate. It first heard about the Share Care model from a local home care agency that operated a home. The Share Care homes are contributing to the entity’s bottom line and are operating at a profit. The impact on the outside community has also been very positive for Wesbury, with residents and staff getting involved in the greater communities in which the houses are located. That community involvement is something I plan to take back to promote at the Share Care homes within my organization.

Lessons Learned About Share Care 

Wesbury learned early on that, when making renovations, it is best to keep the house looking just like any other in the neighborhood. This way, neighbors do not get a sense that an outside organization is coming in and changing their neighborhood. One of the ways in which Wesbury combats this stigma is by putting the wheelchair access ramp inside the garage. That means the ramp is out of sight when people are driving through the neighborhood.

We have opened two of these homes in the last six months, and we are filling our second one with residents now. During this process, it has become obvious that, with any fewer than three residents, the costs outweigh the revenue. Because of this, filling the home has become a priority. When I asked Wesbury how it combats the cost of census turnover in its homes, I received a simple answer. Currently, they said, the only way to absorb the cost is by scale. The more houses you have to spread the costs of census turnover across, the better the model performs financially.

The Top Challenge Communities Face

What’s the number one struggle that Wesbury — and now St. Paul’s — has with this care model? It’s getting people approved for the waiver. Individuals who apply for the waiver wait, on average, six months for approval to be finalized. And, unlike the Medicaid benefit for the nursing home, there is no presumption of eligibility with the Home and Community-based Services Waiver. This means that someone in need of services cannot start receiving them until final approval is given.

As leaders in our communities, we have the ability to effect change. Organizations like ours and LeadingAge PA can advocate for change to the approval process for the waiver. Additionally, organizations such as mine that are just starting to offer Share Care can work with experienced organizations, like Wesbury, to learn how to navigate the current approval process. Share Care has proven that it can be an effective care model for low-income individuals who need help to live on their own. We just need to work together to make it easier to implement.

Today I’m talking with Maura Z. Richards, Vice President of Business Development at Wohlsen Construction, a top-ranked construction company specializing in senior living. Prior to her current position, Maura spent more than 15 years working in senior living as a provider and consultant, giving her unique insights into finding solutions that are economically and operationally viable to increase occupancy.

Hello, Maura! Thank you for talking to me today! What do you view as the biggest challenge facing older adults in the middle market?

The affordability of senior living communities. We have not completely solved the middle market product challenges to serve the number of seniors that will need to move to — specifically  — an assisted living or memory care community. Seniors will stay home as long as possible — which more times than not means too late — due to the fact that they do not have enough money to afford a senior living community.

What are some common misconceptions about the middle market?

People get confused when you talk about the middle market. They think middle market housing is affordable, but it’s really not. It’s essentially less costly than a traditional senior community, but it’s still expensive. The middle market community is much smaller in size and has more of a model of two bedrooms sharing a kitchen and bath. This type of living arrangement is not one that a prospect seeks until there is a need.  Having been in senior living for many years, I can share that this is not what you want to hear when a prospect comes through the door. You want prospects to move to a community when they are independent  and not making a need-based decision so that they are content with the move and will take full advantage of the lifestyle a senior living community offers.

What are the biggest barriers to building for the middle market?

Building costs and land cost — with both being high, the financial model is hard to pencil out to be affordable for the middle market. Developers look for sites that are outside urban areas to keep land costs down. However, to make the community pencil out, there typically is less amenity space and an apartment layout in which two individual prospects share a kitchen and bathroom.

What is the biggest competition for middle market housing?

People’s own homes and technology. If people can stay in their home and install smart home technology for less than it costs to move to a senior living community, then they will always choose their own home. They will then wait until there is a need to move to a community. The struggle from a proforma perspective is that the higher the acuity level of the residents, the more staffing the community needs.  With that comes higher entrance fees and monthly fees.

Since studies have found that, by 2029, 54 percent of older adults will not be able to afford private pay senior living, how will the industry as a whole need to change? 

The industry will need to look to partner with other organizations to create a mixed-use development that taps several housing options to share in the cost of the amenity space to bring down the cost of senior living.

What types of organizations would be good partners for senior living?

Maybe there is an option for senior living to partner with intergenerational housing options to form a mixed-use development. For example, many universities need additional student housing yet are faced with high construction costs just like senior living. There could be an opportunity for developers to look at student housing and senior housing to share in amenity and community space to lower the costs for both. This would also allow both populations to take advantage of the educational opportunities.

Do you have any other creative ideas that could benefit the middle market?

Another idea I have thought about from a socialization standpoint is to build senior centers on or next to local public schools to leverage intergenerational opportunities and programs. High schools are being renovated all over the country and facing issues of getting funding passed. Why not look at combining the two? The more our younger population interacts with and understands senior needs, the more we will see solutions to take care of older adults in the future. To get youths to understand seniors, you have to put them together.

As communications professionals in the world of marketing, the way we frame language around our products is very important. In the digital realm, it becomes vital — especially in a world of search engine marketing and optimization that’s driven by customer vocabulary. Through this, users influence how organizations market themselves; meanwhile, providers try to influence a user’s search language by changing industry-accepted terms.

A great example of this is the term “Continuing Care Retirement Community.” It was adopted by the aging services field, but over time, it failed to truly describe what consumers want. Recently, the industry leaders (including our team at Varsity) pulled together to recommend the term “Life Plan Community” be adopted as a more aspirational term for the Boomers. Let’s pull back a bit further and think critically about how we continue to use language as senior living marketers.

If you perform a Google search for retirement communities or senior living options, you’ll generally run into two euphemisms used by marketers — “luxury” and “affordable.” I ask myself, if I were in the market for aging services, what do these terms say to me?

Luxury — “Luxury means the finest amenities and high-end dining” or, perhaps, “Do I have enough money to afford this property?”

Versus

Affordable — “Oh, great. A community that won’t break the bank and that I could actually afford” or, perhaps, “I guess I’ll settle for whatever an affordable community has because I can’t afford luxury.”

There are upsides and downsides to how we interpret these shorthand phrases. Certainly, marketers like them because they force consumers to self-segment. Those without assets will naturally avoid luxury, and those with money wouldn’t be interested in the more limited offerings found in the affordable space. Certainly, as we manage search engine marketing campaigns, providers often identify “affordable” as a negative keyword, meaning that if a user enters that phrase in his or her search, an ad will not be shown because the organization assumes that the user can’t afford its offerings.

Maybe you’re like us, and you’ve noticed something missing. Yes, just like the rest of America, we’re forgetting the middle class. Middle class used to be something everyone aspired to. It was a positive to be middle class, and people were proud of that label. Today, it seems that if you aren’t part of the upper, then you’re just part of the lower. When did that change? When did aging services stop engaging with the middle class?

For instance, let’s look at these search terms from Google Trends. This data is only for the United States, over the last 12 months, and shows the popularity of each phrase when it comes to searches:

The blue bar is “affordable senior living.”

The red bar is “luxury senior living.”

The yellow bar at the bottom is “middle class senior living.”

As you can see, no one searches for “middle class senior living.” There are plenty of reasons why this may be, but certainly it’s not a term used by providers to market their products. No one wants to be labeled “middle class,” it seems. What, then, is the term used by average Americans to find a middle-of-the-road community? In this case, there isn’t a universal answer — and, in my mind, that’s an opportunity.

While many communities are focusing on luxury and are trying to bring in asset-laden residents, there’s a strong middle class, driven by Baby Boomers, that are going to be looking for a retirement option. If providers can find a way to cater to this segment, they could potentially have much to gain. Marketers need to begin working now to define what middle class retirement accommodations look like and educate potential residents on how to find them.

Language is an amazingly powerful tool. As marketing professionals, we have a way of impacting how people perceive and interact with the products we make. No one would describe an Apple product as an affordable brand, but many do think of it as a luxury. Yet, for many Americans, it’s a luxury they can afford and represents a certain amount of prestige and status.

As we look to the future of marketing in the senior space, how do we capitalize on this and tell middle class Americans that a quality retirement experience is a luxury they, too, can afford?

That’s something that we, at Varsity, are thinking quite a lot about.