15 Networking Techniques

for Senior Living

The following techniques enable senior living communities to establish strong personal relationships with prospective residents.  These relationships are often critical to the prospect’s move-in decision.

1.  Establish common ground. Build on the prospect’s expressed interest in senior living.  It is often helpful to share aspects of your own life that will appeal to the identified interests of the prospect (e.g. a favorite pet).

2.  GIVE something of “value”. Take a plate of baked goods or other small gift when visiting the prospect in their home.  Begin a phone call by discussing a topic of general interest to seniors (e.g. H1N1 flu shots) including happenings at your facility.  Senior citizens will generally value the time you spend with them.

3. Make the contact about THEM. Tell the person that they are important and show you care about them as an individual – not just as a potential customer.  Be sincere in doing or saying something that will brighten their day.  Respect their time by asking if “this is a convenient time, or should we schedule a specific time tomorrow?”

4. Have a REASON TO CALL.  Of course, you want a move-in, but that is NOT the reason for the contact.  Your PURPOSE might be to invite them to an event or simply to follow-up about something that was going on in their life.  THINK:  Which statement is more likely to receive a favorable response?

“Hi, I’ve got a one bedroom unit open”; or
“Hi, the last time we spoke, you were planning to attend your granddaughter’s wedding – how was it?”

5. Do your RESEARCH. If everyone has recorded notes after each interaction, a wealth of information before contacting the prospect.  Identify potential topics of conversation by reviewing information about the spouse (living or dead), children’s and pet’s names, where the family goes to church, likes and dislikes, what they did before they retired, and clubs they’re interested in (e.g. “Red Hatters”).

6. Ask questions. The elderly are ignored by many people in our society who fail to show the dignity and respect they have earned for their life accomplishments.  By inquiring about their life, you demonstrate appreciation and help them to feel “worthwhile”.  You will be amazed at what you’ll learn and may even find that you really LIKE the senior.  In turn, this friendship will provide you a competitive advantage when it becomes time to move into a facility.

7. Don’t sell.  Listen. This is probably the biggest mistake made by new managers / sales people.  They are so concerned about listing all of their features and amenities that they forget to listen to what the prospect is trying to tell them.  THEN, and only then, will they know which points to emphasize in subsequent contacts.

8. Play Sherlock Holmes. The vast majority of residents don’t move into an independent or assisted living setting unless they have a NEED and have experienced a fairly recent LOSS.  Interestingly, couples frequently make the first inquiry, but only the surviving spouse will move-in.  Seniors are often reticent about disclosing their concerns.  Yet, by discovering their unmet need(s) and presenting your services as a solution, you can generate a move-in.

9. Plan the Work. Getting move-ins is a numbers game.  Successful buildings will have 5 to 15 prospects (depending on the level of care) for each unit.  Different members of the sales team should be assigned a specific target of contacts (i.e. phone calls, personal visits, tours, etc.) for each day / week.  Goals should be set for “contacts made” and not just attempts – it may take 5 or more attempts for each successful contact.

10. Work the Plan. Your sales efforts must be a PRIORITY.  Set your target and then follow your plan every dayThis is what relentless follow-up is all about. There will always be a reason why you can’t get out of the building for a home visit or make all of the assigned phone calls.  You must be self-disciplined to not accept these excuses and find a way to meet your targets.

11. Make every contact a QUALITY interaction. Remember that the ultimate goal is to “score” a move-in. Making calls in which you fail to “connect” with the prospect is simply wasting time.  Instead of padding your statistics by mailing the activity calendar to everyone, select a handful of prospects to invite for a specific program that your research shows would interest them.  Then follow-up.

12. Be Prepared for No Response. Have a customized message ready to leave on voice mail or a hand-written note to leave on the door if the prospect doesn’t answer the call or “knock”.  Include a “hook” to prompt a return call.

13. Get away from the trite “Lunch and a Tour”. It’s formality lacks warmth and sincerity. Because everyone does it doesn’t mean it’s the best approach.  It says “I want to make a sales pitch” with a structured agenda on my schedule.  INSTEAD, invite them for a friendly “visit” and focus on their wishes.  After chatting for a while, you will probably still get around to a tour – likely in response to some point or question raised by the visitor.  It also becomes perfectly natural to ask them to stay for a meal.

14. Don’t expect to “Close”, but be Ready for the Opportunity. This is a major LIFE DECISION for the prospective resident.  It usually takes time, so don’t put undue pressure on yourself or try to force the issue with a “hard sell” approach.  It’s okay to ASK, but the prospect will generally let you know when “they’re ready”.

15. Never Give Up! At times, it seems as though you’re struggling up a mountain because of the lengthy sales cycle.  Relentless Follow Thru will insure that YOU are there when the prospect is ready to make that move-in decision.  Like the little blue engine in this adaptation of Watty Piper’s “The Little Engine That Could”, you should maintain a positive attitude and keep chugging!

Move-ins

A Process

Not

An Event!

Click on the following link to preview a PowerPoint Training Session that highlights frequent steps in a Move-in Process.

Move-in Process

POSITIVE ATTITUDE — POSITIVE IMPRESSION

“Disney makes you wait on line for a ride even if the park is empty.”[1] Seth Godin uses this example because of the recognized marketing genius of Walt Disney and his organization.  He goes on to point out that “a full restaurant is more fun than an empty one”[2] as he emphasizes that creating demand is a complex process – because humans are complex individuals.

These concepts have several direct applications to the senior living industry.  But, first, a word about the placebo effect.  The past couple of years have delivered many marketing – as well as operating – challenges; and it is easy to slip into a negative attitude about the futility of your marketing efforts.  Of course, this can be a self-fulfilling prophecy. On the other hand, Seth observes that just as a placebo often produces positive results: “If we believe we’re going to get better, perform better, make the sale, etc., it often occurs that we do.”[3]

If you are the sales person (the individual interacting with a prospect), you must believe in your product and approach the tour, discussion, etc. on the basis that it WILL close!  We know that the sales cycle is a process, but you have to approach each contact as though “this is the one”; otherwise, human nature will lead to just going through the motions and neither you nor the customer will be satisfied with the interaction.

But, this goes further than just the attitude of the tour guide.  The attitude permeates the entire organization.  A classic example is whether to set all of the tables in the dining room for every meal, even when the building has multiple vacancies.  A cost-conscious manager will say to set only enough tables to seat the number of expected residents and guests for the upcoming meal.  They’ll point out that the residents will spread out to all the tables causing more effort in serving the meal and requiring additional staff time in clearing and sanitizing tables and cleaning unused table settings.  So, it’s certainly tempting to save time and money by setting only the minimum number of tables and place settings.

Now, let’s look at the same situation from a marketing / customer service viewpoint:

  • Wouldn’t the current residents be happier having the freedom to sit anywhere they want in the dining room?
  • Shouldn’t the building be TOUR READY every day?  Wouldn’t you prefer to have a table already set and ready if you have guests that you would like to invite for the meal?
  • Shouldn’t management convey optimism that guests will show up for a “tour and a meal” and be ready for them?  Maybe, that attitude will carry through to other staff members and encourage them to demonstrate “pride of ownership” in the building.
  • WHY ADVERTISE THE FACT THAT YOU’VE GOT A LOT OF VACANCIES by showcasing a “half-empty” dining room?

It’s human nature to assume something’s wrong with the choice that isn’t in demand.  Think about it. When one ride at Disney World has a line and another has none, don’t you wonder what’s wrong with the one without a line?  Is that the one your kids are going to want to ride? Probably not.

You create that same question in the mind of your prospective resident and their family when they see a dining room that looks empty.  So, don’t shoot yourself in the foot; create a positive atmosphere and be ready to be full today.


[1] Seth Godin’s blog article:  “Ethical placebos (stunning, but not actually surprising)”  http://sethgodin.typepad.com/seths_blog/2011/02/ethical-placebos-stunning-but-not-actually-surprising.html

[2] ibid

[3] ibid

Continuing Challenges or OPPORTUNITY …

for the Senior Living Industry?

Will operators continue to “cut costs” – even when it entails reducing services for the residents?

Will the focus continue to be on “need-driven” admissions and move-ins?

Will the average age of residents continue to increase while the average length of stay decreases?

Will new development and innovations continue to stagnate?

Will the “Aging in Place” movement continue to gain strength with seniors choosing to buy more services that help them stay in their personal residences?

OR

Is this the year that:

a)       The industry begins to prepare for the changing demands and needs of new generations of potential residents? [READ MORE]

b) Progressive visionaries challenge the “status quo” in design and operational philosophies?  [Update to Follow]

c) More emphasis is placed on providing a quality lifestyle for the resident, regardless of his/her medical (physical & mental) limitations/capabilities?  [Update to Follow]

d) Operators embrace new technologies to provide a stronger value proposition as a viable alternative to the prospect remaining in their own home? [Update to Follow]

e) New entrants from outside the industry and foreign investors assume leadership roles with new energy and vision?  [Update to Follow]

The Bobby-sox Generation

a Target Rich Environment for Senior Living

The first members of the “bobby-sox” generation (born 1935 – 1945) will turn 76 in 2011.  As discussed in “Do Senior Living Communities Need a Wake-up Call?” and “Do not go gentle into that good night[i], this generation will be more demanding and EXPECT many amenities (considered options today) to be included in the standard package in the future.  The bobby-soxers will be less willing to compromise their independence for the “one-size-fits-all” approach utilized in many of today’s senior living facilities.

Recognizing and understanding the desires of the customer is essential in any business.  In senior living, we need to revise our mental images of the stereotypical resident if we are to successfully market to this generation.  Because of the preponderance of celluloid images that keep our heroes forever young, it’s hard to imagine that ELVIS would be 76 this month if he were still alive.  Do we really believe that this generation whose icon flew his entourage in a private jet from Memphis to Las Vegas just to get a “PBJ”[ii] will be satisfied with a set menu at set times in a set place as is common in many communities today?

Is it reasonable to assume that the generation that fostered the 20th Century success of higher end hotel companies (e.g. Marriott, Hyatt and Four Seasons) – with concierge floors, lounges, suites, king-size beds, etc. – will accept 200 – 300 square feet of personal living space?  Will they be prepared to “give up” their home to move into a space that’s probably smaller than their current bedroom?

Will the members of this generation who have been used to success, affluence and independence be prepared to turn over control of all their daily activities to facility staff with programs such as arts & crafts – see “Summer Camp for Seniors” – as their only daily stimulation?

This Bobby-sox generation is often overlooked as it is sandwiched between the “Greatest Generation” – which includes the World War II veterans – and the huge numbers of “Baby Boomers”.  Yet, there are over 20 million bobby-soxers in the U.S. today, accounting for approximately 7% of the total population.  This group accounts for over 50% of the 65+ population (Medicare eligible) in the country and there are now 15% more living members of the Bobby-sox generation (10 year group) than all prior generations.[iii]

The following pictures depict a sampling of well-known Bobby-soxers from business, government/political, sports and entertainment industries.  Although these celebrities are more recognizable, each represents many other everyday members of the generation from all aspects of society.

See which, if any, of these individuals come to mind when you think of 65 – 75 year olds.   And then, THINK AGAIN because they are rapidly becoming your TARGET DEMOGRAPHIC.

NOW IS THE TIME TO BEGIN PREPARING!

 

Frankie Avalon (1940) and Annette Funicello (1942) – Singers, actors & former teen idols; she was the favorite Mousketeer

Alan Alda – Captain Hawkeye Pierce on M.A.S.H.  (1936)

Tom Brokaw – TV News Anchor & Author of “The Greatest Generation” (1940)

Bill Cosby – Comedian & Actor(1937)

Neil Diamond – Singer/Songwriter (1941)

Elizabeth Dole – U.S. Senator & Cabinet Member; head of American Red Cross & wife of Presidential nominee Bob Dole (1936)

Mike Ditka – Pro Football Player, Coach & TV Commentator (1939)

Michael Eisner – Disney CEO (1942)

Jane Fonda – Actress & Political Activist (1937)        

Harrison Ford – “Indiana Jones” Actor (1942)

Morgan Freeman – Actor (1937)

Louis Gerstner  CEO of IBM (1942)

Joe Gibbs Hall of Fame Pro Football Coach  with the Washington Redskins (1940)

John Kerry – US Senator & Presidential Candidate (1943)

Sandy Koufax – Major League Baseball Pitcher & Hall of Famer (1935)

Ralph Lauren – Fashion Designer (1939)

George Lucas – Creator of “Star Wars” (1943)

John Madden – NFL Coach & TV Announcer (1936)

John McCain – Retired Navy Captain, Senator & Presidential Candidate (1936)

Mary Tyler Moore – Actress (1936)

Joe Namath – New York Jets Quarterback & Super Bowl Champ (1943)

Jack Nicholson – Actor (1937)

Al Pacino – Actor  (1940)

Colin Powell  Retired General (US Army), Chairman of Joint Chiefs of Staff, & Secretary of State (1937)

Paul Prudhomme – Chef (1940)

Robert Redford – Actor & Producer (1936)

Pete Rose – Professional Baseball Player (1941)

Diana Ross of the Supremes (1944)

Jay Rockefeller – U.S. Senator and former West Virginia Governor (1937)

Barbra Streisand – Singer & Actress (1942)

Ted Turner Entrepreneur & Media Mogul (1938)

Tina Turner – Entertainer (1939)

Jack Welch – G.E. Chairman/CEO (1935)

Raquel Welch – Actress (1940)

Jerry West – NBA Icon (1938)

ADD A COMMENT

to describe a BOBBY-SOXER who represents this generation [They don't have to be well known like the people above].

PLEASE discuss ways in which their personality, needs and demands will be different than the “Greatest Generation” and/or individuals currently residing in senior living communities.


[i] Both published by Art Carr on the Progressive Retirement Lifestyles BLOG.  Go to http://wp.me/pCemc-3f and http://wp.me/pCemc-5x respectively.

[ii] Peanut butter and jelly sandwich.

[iii] 2010 projections are from: Table 12. Projections of the Population by Age and Sex for the United States: 2010 to 2050 (NP2008-T12), Population Division, U.S. Census Bureau; Release Date: August 14, 2008

Building the NEW Aging Continuum

The following presentation was presented during the “Aging and Technology Industry Webinar”  hosted by GrandCare Systems and sponsored by Dakim Brain Fitness on September 9, 2010.  The PowerPoint presentation may be viewed by clicking here: Building the New Aging Continuum[i].

Participants in the WEBINAR stated that it was “fantastic, always learning”, “so true”, “Great presentation”,  “I love this image”, “This is resident centered care writ [sic] large”, and “Terrific presentation!!!”.  One commented, “I have been waiting for existing senior living communities to actively reach out to the greater community”, while another said, “This all helps take away the dark scary thoughts of ‘retirement living’.”

In addition, the host stated that the presentation “put into words the value of aging technologies to care providers and the NEW continuum of care. Many  in the aging & technology industry have been struggling to express this, especially to our aging service colleagues.”

THE COMPLETE SCRIPT FOR THIS WEBINAR may be accessed below. (more…)

Beyond “DEATH and Dying” – Part 4

Bargaining

The previous installment[i] introduced the concept of hope as a key to managing grief and assisting the individual to move from ANGER into the BARGAINING stage. This segment will expand beyond the concepts discussed by Dr. Elisabeth Kubler-Ross in “On Death and Dying”.  With her focus on terminally ill patients, she talks about “entering into some sort of an agreement which may postpone the inevitable”.[ii] She states that these “bargains” are generally made with their God and goes on to give examples of  mothers that want to live long enough to see their daughter married, or new grandchild born, etc.

There is a further opportunity for those providing services for seniors who have already suffered losses.  They may utilize the natural desire/need to bargain by presenting realistic options as positive alternatives for current or future residents. Success is achieved when the senior begins to approach each new day with HOPE for positive experiences instead of focusing only on their “losses”.

The following guidelines should be considered when negotiating a bargain and building hope for these seniors:

  • We can’t replace their loss – DON’T TRY!

Think of the parent who buys a new puppy to relieve their child’s sorrow over the death of a pet.  The child may initially reject the new pet feeling that paying attention to the new puppy is disloyal to the memory of their “friend”.  Ultimately, the child will learn to love the new pet – not as a replacement – but because of its own unique qualities.

  • Don’t minimize the loss; no one else can determine the relative importance of a particular loss to the individual.

How often have you heard someone say (well-meaning, of course), “Oh, it’s not that important; you’re spending too much time thinking about that”, etc.?  Whether the senior lost a favorite piece of jewelry, a loved one, or the ability to drive their own car, that loss is real to them.

  • BARGAIN = COMPROMISE.  The secret is to demonstrate enough value to be gained by your proposal that will offset what the senior believes they are giving up.

For instance, older adults who are asked to give up their personal residence will seldom see enough value to offset the loss of the home by simply emphasizing the “real estate” aspects of the senior living community.  As Jason Popko observes:  a HOUSE is an “object that can be bought and sold” while a HOME has “meaning and attachment to … personal living space” that can’t be “bought or sold”.

The new building may even be better, safer, etc. than the original, but the individual won’t/can’t hear that at this stage.  Smart marketers will focus on lifestyle, the benefits of socialization, interactive activity programs, etc.

  • Don’t create false hopes with unrealistic expectations.

It is tempting to make promises, especially when trying to convince a prospect to move in, but make sure you can deliver what you promise.  Otherwise, the short-term gain will be far offset by the negative reputation that will be generated.

  • Grieving is a complex emotional process, but don’t be afraid to try and help.  Understand that it’s natural for the person to slip backwards into DENIAL and ANGER. Don’t take it personally.

Remember that HOPE is the KEY and TRY AGAIN!

  • Begin building relationships in the marketing process.  Then draw upon the knowledge gained to generate attractive options as the resident experiences the inevitable losses that come with aging.

The ability to convey compassion, show support, communicate an understanding of the grief process and present creative options will facilitate move-ins and reduce move-outs.

  • ALWAYS, treat the senior with dignity and respect and don’t insult their intelligence.

There is a tendency by some in the industry to “talk down” to the residents and treat them somewhat like children:  “Now, honey, you don’t want to do that…”   Respect their ability to understand the significance of their loss and the value of the proposed alternatives.

CASE STUDY: Jim lost his wife Tammy a little over a year ago.  He has been in declining health for a number of years with deteriorating eyesight (in fact, he is “legally” blind), but his wife had always promised him that she would take care of him and that he would never have to go into a nursing home.

Jim was a successful sales executive who used to be the “life of the party”, was active in his church, and attended all his college’s home games.  Due to his eyesight, he had to forgo these activities and retrofitted his 2-story colonial with a first floor bedroom.

Jim’s son Dale and his family moved in to take care of Jim.  But, both Dale and his wife work and Jim is often left at home with little to do all day.   Jim’s upset because Tammy often sat and had an afternoon “toddy” with him, but now everyone seems to have their own priorities with little time for him.

Some days Jim tries to do the things he “used to do”; this often causes additional problems (e.g. he fell and broke several lamps). Other days, he is angry with the grandchildren for being too loud, leaving their “stuff” in the way, etc. He is frustrated because he no longer seems in control of his “own home”.

Dale has come to you for help.  He has confided that several other communities stated that Jim seems like too much of a problem and they either want too much money for “specialized care” or said they aren’t interested in him as a potential resident; one even suggested that Dale contact a nursing home.

How would YOU handle this situation?

Please CLICK HERE to post your comments and suggestions.


[i]Beyond ‘DEATH and Dying’ – Part 3   Anger

[ii] “On Death and Dying”, Chapter V, by Elisabeth Kubler-Ross, M.D., originally published in 1969

AGING-in-PLACE – Threat or Marketing Opportunity?

A SWOT analysis, identifying Strengths, Weaknesses, Opportunities & Threats, is often used in developing the marketing strategy for an individual community.  As discussed in several prior articles in the “Wake-up Call” series, the aging-in-place concept should definitely be viewed as a threat to the traditional senior living community industry.

This phenomenon is clearly gaining traction and as reported in the Orlando Sentinel, “it even has its own National Aging in Place Week, which falls on Oct. 11-16 this year.”[i] All indications are that this stated preference will become even more prevalent as succeeding generations age into the historical target demographic for senior living communities.

On the other hand, management, marketing and sales can turn this challenge into an OPPORTUNITY.  It is becoming clearer that an aging adult will need to adapt their living space to be able to continue to effectively “age-in-place”.  For instance, the Orlando Sentinel article identifies the following AGING-IN-PLACE Architectural Features:

Wider doors, hallways and toilets

Same-level transitions or ramps instead of steps

Roll-in showers with wide, doorless entries, grab bars, nonskid tiles, built-in seats and handheld shower units

Walk-in closets, casement windows, lever-style door handles

Waist-high kitchen appliances and storage drawers.

How many of these features are provided as “standard” in your community?

Are some of these features included in selected apartments (e.g. ADA[ii] or “handicapped” units)?

How often do you focus on these features when conducting a tour?

Is your company willing to add certain of these features to accommodate the needs of a potential resident and get a move-in?

Can you speak intelligently about what it would cost the individual to make these changes in their own home?

Some organizations, especially independent living communities, have been reluctant to include several of these safety features for both cost and ambience reasons.  The philosophy of these companies has been to “wait for the customer to ask for it”.  For instance, one IL only included grab bars in their ADA units because they didn’t want the building to look “too much like an assisted living facility or nursing home”.  After losing several prospective residents, the owner agreed to make modifications – AS NEEDED – but encountered problems in retrofitting the showers.

Another industry leader uses lo-rise toilets throughout their buildings, except where ADA regulations require raised toilets.  In most cases, they will “switch-out” the toilet if the resident specifically requests it, but leave it up to local management to handle.

The fact that aging adults are prepared to add these architectural features in their own home should tell builders and owners that it’s time to wake-up. Items such as grab bars, hi-rise toilets and walk-in closets need to become as standard as wide hallways in ALL levels of senior living communities.

Taking this step may initially increase construction costs slightly, but will positively impact marketing. It will enable sales people to build better relationships by focusing on CAPABILITIES vs DISABILITIES!

In fact, safety features such as grab bars, non-skid flooring, etc. may be marketed as part of a HEALTHY AGING concept.  Aging is a normal process and it should become natural to either add these features or move into living accommodations that were designed to promote resident safety.  As senior living specialists, we should promote these features as preventive measures for a healthy aging lifestyle instead of only adding them AFTER the individual needs them.

3 things happen – ALL NEGATIVE – when we make a prospect ASK for features that they may have already installed in their own home:

  • We place them in an awkward / embarrassing situation when they are forced to admit and focus on a frailty.  NO ONE likes to be reminded of their weaknesses – why should we expect a senior to be any different.
  • The value perception is diminished.  The prospect will question:  “WHAT ELSE is LESS than I have at home?” or “WHY don’t they have these features – I thought they were the experts?”
  • They may never ask the question, nor learn that options are available.  They will simply go elsewhere that does provide the desired features.

If your community does offer these features, how do you work it into the conversation and turn them into selling points without making the prospective resident feel “disabled”?

For instance, a 6 – 8 foot hallway is clearly wide enough to navigate a wheelchair, but that’s not what most prospects want to hear.  On the other hand, you might point out how spacious and well-decorated it is and then ask the question as to how it compares with the prospect’s home. [Note:  the average hallway in a single family residence will be 36 inches or narrower.]

The key is to sell a LIFESTYLE vs a litany of real estate features.  This approach will enable you to establish a personal relationship with the prospect and present the retirement community as a positive option, instead of something they will “have to do”.

Show the prospect how different features are designed to keep them safe and able to maintain their independence.  Observe that very few private residences are designed with these safety features even though statistics show that 1 out of every 3 seniors (over 65) will fall each year.[iii] This may prompt a discussion about the type of safety features they have or lack in their home and lead to the conclusion that the “smart” choice is to move-in with you!

A great follow-up question is whether they know what it would cost to retrofit their current home with the same features that you include in their basic rent.  Depending on the extent of the modifications, costs can easily run between $20 – 40,000.  (How many months of service would that buy at your community?)

Invest a little time to establish greater credibility by identifying contractors that are doing those services in your local community and finding out exactly what they charge.

Should the prospect “know” what the costs are, MOVE THEM TO YOUR “HOT LIST”!  They are ready to do something – now all you have to do is convince them that you offer their best alternative!

PLEASE CLICK HERE TO SHARE YOUR OPINION AND/OR READ THE COMMENTS OF OTHERS


[i] “Seniors embrace aging in place”, Jean Patteson, Orlando Sentinel, July 9, 2010.

[ii] Americans with Disabilities Act

[iii] International Council on Active Aging

What Does the Future Hold for the Senior Living Industry?

Dust off the crystal ball, get out the Ouija board and tarot cards, and check with your swami! There are signs that we are coming out of the recession, so will the senior living industry quickly rebound and get back on track?

After all, the “graying of America” is no secret. The Administration on Aging[i] reports that the number of “older Americans” (i.e. over 65) grew by 4.5 million to 38.9M in the 10 years ending in 2008 and are expected to increase to 55 million by 2020.  The 85+ population will increase by 43% to 6.6M from 2000 to 2020 and will just begin to include the “bobby-sox generation (born from 1935 – 1945) with NO baby-boomers in that statistic.  So, won’t that create a “rising tide that floats all boats”?

OR, are there other forces at work that will have a profound and long-lasting impact on the industry? Have these forces been gathering strength behind the scenes while the industry accepted blanket excuses for census declines because of the real estate problems and loss of portfolio values?

Perhaps, now is the time to learn some lessons from the Long Term Care Industry. The 1980’s were “heady” days for that segment of the senior care spectrum. Each year, more facilities and beds were added and the financial markets were happy to fund the growth and consolidation of the industry. They read the statistics at the time and KNEW that the demand would continue unabated “for our lifetime”.  Beverly Enterprises was the clear growth leader after securing the first public equity funding in 10 years in 1980. This and other financings fueled their growth from 100 facilities in 1980 to almost 1200 by the end of the decade.  Hillhaven and others soon followed suit.

So, what happened?  Why did Beverly shrink to less than 300 buildings?  Why has the total number of SNF beds and facilities been decreasing each year (to only 16,000 facilities today)? Why didn’t the demographics continue to drive the growth of the nursing homes?

Obviously, there is no one universal answer to these questions.  Changes in the hospital payment system clearly had an impact on the type of patients being discharged into the SNFs. Meanwhile, the intermediate care (“walking wounded”) residents, and especially the private pay, disappeared from the nursing homes.  WHY?  Because of the rapid development of alternative services for these individuals:  ASSISTED LIVING, INDEPENDENT LIVING and HOME HEALTH.

Americans continue to live longer and the number of older Americans has continued to increase.  The difference is that they no longer have to look only at nursing homes as their source for elder care and support. The introduction of these other alternatives caused a major and permanent shift in the elder care paradigm.

TODAY’S SENIOR LIVING COMMUNITIES FACE THE SAME TYPE OF CHALLENGE AS THE NURSING HOME OPERATORS IN THE 1990’s.

Various studies[ii] have shown that between 85 – 90% of older Americans wish to age-in-place and there are a multitude of new technologies being developed to assist them in achieving that goal. Meanwhile, both independent and assisted living communities are increasingly hearing: “I’m not ready yet!” when communicating with their leads. The question may soon change from WHEN they’re ready to “Will they ever be ready to move-in?”

With the poor economy, it has been very easy to bury our head in the sand and assume that “I’m not ready yet!” is a subtle excuse for the prospect’s inability to afford the services at this time. Although this may be true, it’s also likely that newer generations of prospective residents are less willing to compromise with lifestyle choices than their older siblings and/or parents.

Currently, many assisted living facilities have minimized their census drop by focusing on potential residents with heavy care (and/or memory care) needs. This has been a decent short-term solution to the economic downturn, but parallels the nursing home industry’s gravitation towards heavier, skilled and even sub-acute care.  While they focused on moving those types of patients in the front door, the lighter care residents were going out the back door and into the new assisted living communities 10 years ago.

WE MUST OPEN OUR EYES AND RECOGNIZE THE THREAT OF THE AGING-IN-PLACE PHENOMENA! Otherwise, assisted living will simply become “junior” nursing homes and independent living will struggle to find suitable residents.

As ALFs become more like nursing homes, with heavier and heavier care residents, the probability of increased government oversight and regulatory requirements increases. When that happens, the flexibility to run the buildings with a consumer driven approach will decrease as the cost of care goes up.  Not a pleasant forecast!

Will the government step in and dictate changes to the industry as they’ve repeatedly done for nursing home residents? For instance, while many senior living communities still require all residents to dress for breakfast and be in the dining room at 8am sharp, the new MDS 3.0 being implemented October 1, 2010 for nursing homes requires that residents be allowed preferences for time to awaken, etc.

In a private-pay, “resident-first” environment, these would appear to be “non-issues”.  Yet, one female resident complained: “I worked all my life and had to get up in the morning.  Now, I’m retired and don’t think I should be made to get up and get dressed by 8 o’clock in order to have breakfast!”

We need to learn from the nursing homes’ history where the population that was financially able to pay privately for their services “voted with their feet” as new alternatives evolved. This group told nursing home operators that their physical plants, care options and lifestyles did not meet their demands. Are prospective residents telling senior living communities the same thing today?

To counteract the aging-in-place THREAT, operators need to re-evaluate every aspect of their services to determine ways to add greater value to their prospective residents.  Future residents are likely to want more options and choices, with fewer rules and restrictions. Socialization and lifestyle enhancements (probably more than upgrading the appearance of the building) need to be strong marketing points.  Incorporating some of the “stay-at-home” technology into the senior community may be advisable.

Let Progressive Retirement Lifestyles help you with this evaluation process and turn the aging-in-place challenge into an opportunity. Call Art at 615-414-5217 to discuss the creation of unique outreach programs that provide services to and generate revenues from your prospects who aren’t “ready yet”.

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[i] “A Profile of Older Americans: 2009” published by the Department of Health & Human Services’ Administration on Aging.  CLICK HERE for link.

[ii] For example, see Tessa ten Tuscher’s Investor Presentation for Living Well Assisted Living at Home on SlideShare on LinkedIN.

Beyond “DEATH and Dying” – Part 3

Anger

Meet Harry.  Every building has one – the resident who is NEVER HAPPY.  “The oatmeal is lumpy.”  The building’s too cold; you keep the thermostat too low. You people don’t understand or care about the needs of old people!  I never had this problem at home.”

Sound familiar?  It might be Harry, or Mabel, or Mrs. Smith but the common characteristics are that you can’t seem to make them happy and they often lash out at employees and even other residents for no apparent reason.  They may be very vocal in complaining about other resident’s “disabilities” – e.g. he states loudly in the dining room “There are too many #*&^! walkers in this place; they’ve put me in a nursing home with a bunch of old, sick people!”

In “On Death and Dying”,  Dr. Elisabeth Kubler-Ross taught us that ANGER is a normal human reaction as a part of the process of grieving for a loss.  She says: “When the first stage of denial[1] cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment.”  Many older Americans don’t understand WHY they have suffered this loss – i.e. the death of a spouse, inability to easily accomplish physical tasks that used to be second-nature to them, a reduction in mental capacity and clarity, or even the loss of certain bodily functions such as continence.  These cause a great deal of frustration for the individual who questions what he/she did wrong to now be faced with this loss.  They ask “Why me and not so-and-so?”  As a result, they often express their resentment towards others who are not similarly affected.

Dr. Kubler-Ross points out that anger is often “displaced in all directions … almost at random” and that family and staff members often find it very difficult to cope with.  Even worse, the anger often feeds on itself and leads to an increasingly problematic cycle.  Especially when the resident believes they have been forced to move into the facility, “the visiting family is received with little cheerfulness and anticipation, which makes the encounter a painful event.”  The family members “either respond with grief and tears, guilt or shame, or avoid future visits, which only increases the resident’s[2] discomfort and anger.”  And, of course, that just drops the problem in the lap of the on-site management.

Compounding this situation is the senior’s perceived loss of independence and control, coupled with their fear of the unknown.  They faced many challenges throughout their adult life and generally found a way to overcome or at least handle those concerns.  Now, they are being forced to deal with the effects of aging and their own mortality, while society and even their own family tell them that they need “help”.   So, if they can’t control their own situation today, what chance do they have to control it in the future?

We know that Harry uses a cane but we don’t know why at this point.  It could be arthritis, a joint replacement, effects of a stroke, or general weakness.  However, when he sees the walkers in the dining room, he knows that might be the next step for him.  He doesn’t want to be reminded of that potential or that he doesn’t know how to stop it from happening so he “acts out” his anger.

How Does this Concept Impact Marketing?

Consider the following points:

  • Unhappy residents are not long-term residents. They will move themselves out, their family will get tired of the complaints and move them out, or their angst may lead to an earlier death.  Regardless, the community will have to find a new resident to fill the vacancy.
  • STUFF HAPPENS in any building.  Most of the time, residents are relatively understanding and management can fix the problems and move on.  However, the “angry resident” stirs the pot with their irrational complaints.  Sooner or later, the rest of the residents begin questioning whether the complainer is “all wrong” and become less tolerant of the management and staff.
  • Likewise, family members forget how difficult Harry used to be for them to handle and have a tendency to start blaming the staff for Harry’s attitude.  {They’re wrong of course, but who’s talking rationally?}  This can lead to negative publicity in the general community.
  • You obviously don’t want Harry to interact with prospective residents during a tour or marketing event.

We once found a “disgruntled” resident who liked to sit outside the front door of a building that had a very low closing rate.  We then found out that the resident was expressing her anger to everyone that came into the building.

What Can We Do?

First, resist the temptation to take the quick move-in that is driven by the children instead of the potential resident.  You are risking a time-bomb if the prospective resident doesn’t take an active part in the tour, discussions, etc. and at least buys into the decision.   Don’t “gang-up” with the family members to force the prospect to move in before they have completed the psychological grieving process. [3]

As discussed in earlier parts of this series, communication is key.  The more you understand about the types of losses the individual has recently endured (See Part 1 for examples), the better you will be able to help de-fuse the anger.  However, this requires that you take the time and spend the energy to establish a personal relationship with the prospect / resident.

Understand that anger is a normal AND NECESSARY step in the healthy grief process.   Educate your staff to the importance of remaining calm and not allowing the resident to “bait” them into losing their temper.  Kubler-Ross advises: “don’t get into unnecessary arguments” over issues that are “often totally irrelevant.”  Remind the staff that the anger being displayed generally has nothing to do with them!

Avoid the tendency to ignore and further isolate the troublesome resident.  This gives them a legitimate reason for complaining and often leads to further “acting out” with escalating demands and louder and more public complaints.

Give them some attention.  Similar to a misbehaving child, their behavior is a cry for help.  They want to be “unique”, but still loved and accepted.  They need to know that someone knows they are there and cares for them.  At the same time, let them know that they don’t have to raise their voice to get your attention.

One of the secrets to managing grief is to generate HOPE for the future.  Recognizing the natural fears of the senior residents, focus on their CAPABILITIES instead of disabilities.  Encourage them to try new things, make new friends, etc.  The key is to get them to look favorably to the future which will cause the past losses to fade in importance.

PLEASE SHARE YOUR EXPERIENCE(s) WITH ANGRY RESIDENTS BY COMMENTING BELOW. A short background synopsis of the individual would be appreciated.  Indicate how you learned of the underlying losses that were driving their behavior and how you dealt with the situation.


[1] See “BEYOND DEATH” and Dying – Part 2 for a more detailed discussion of the denial stage.

[2] Changed from the original “patient’s”.

[3] NOTE:  I recognize that different rules apply for admissions to Alzheimer’s / memory care units.

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