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”.

READ COMMENTS


[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.

March Madness!

Throughout the country, normally sane men and women, boys and girls go crazy over NCAA basketball in March each year.  65 men’s and 64 women’s teams compete in the annual tournaments to crown the year’s champions with millions of fans who haven’t attended a game all year tuned  to their TV sets.  “Bracketology” is THE buzzwordFinal Four 2013 for several weeks with folks who would never consider going to Las Vegas joining their local pools at work, in neighborhoods – even at church – to pick the winners at each level and cash in on the “big prize”.  EXCITEMENT abounds!

Yet, what about our senior citizens?  Did they retire from all this “hoopla” when they moved into a senior living community?  As a regional director for over 20 retirement centers, I learned that none of these buildings scheduled anything on their activities calendars related to these events.  Several factors potentially contribute to this omission:

  • Some senior living properties become so focused on providing for ALL of the needs of their residents internally, they tend to overlook the importance of keeping the residents aware of and involved in the mainstream activities of the broader community.
  • Some buildings still hold a “rest home” mentality with activity programs limited to the 3B’s:  Bible, Bingo and Birthday.
  • Many activity directors  consider sports related programming as only male-oriented activities and believe that they would not be well received by the majority of residents who are women.[1]
  • Finally, some may simply look at the tournament as something the individual can watch in their own apartment, overlooking the value of socialization in watching the game  with  friends.  It’s strange that we see the value in weekly movies in the TV rooms but don’t consider the benefit of watching and discussing other TV programs in a common setting.

     ACTIVITY CALENDAR TIP:

Because of the number of games in all time zones, there is an opportunity to schedule WEEKEND and EVENING events around the broadcast of these games on numerous days!

In keeping with the philosophy of enhancing marketability by improving the resident experience[2], I directed that March Madness be treated as a current event.

MARKETING TIP:

Identify “prospects” who are currently living alone and might be interested in seeing games.  Invite those individuals to watch a game on your big screen TV with your in-house residents.  Sell camaraderie and the value of their access to the large (and high definition if you have one) TV.

The following game was one of several activities initiated in my buildings.  [Please contact me directly to discuss other activity and marketing ideas that may be built around the March Madness concept.]

March Madness

(Seated Basketball Game)

OVERVIEW:

This is a TEAM sport with two 5-member teams.  This is an age-adapted, adult program designed as a low-impact physical activity suitable for all residents.  The game is played from a seated position to neutralize any height advantage and eliminate restrictions based on

Seated Basketball

Seated
Basketball

the ability to stand and/or walk without assistance.

It is based on the shoot-around game of “HORSE” with 5 chairs placed in front of the basket.  Each participant on each team will shoot from every seat with points scored for made baskets.

ACTIVITY OBJECTIVES:

  1. Promote independence in body and spirit.
  2. Help residents fulfill social & ego needs.  Several residents may achieve self-actualization by participating in their First basketball “game”.
  3. Create new Precious Memories as seniors get the opportunity to showcase their abilities to their families.

EQUIPMENT REQUIRED:

  1. An adjustable height basketball backboard and goal.    The goal works best at 6 feet for an 8 ft. or higher ceiling.  The model shown is manufactured by Little Tykes and may be purchased at Toys-R-Us for about $45.  Remove or cover any reference to the Little Tykes name, age group, etc. (e.g. Use a sticker with the community’s name or logo) to insure that the equipment does NOT convey a “juvenile” nature to the activity.

The manufacturer recommends that the base be filled with sand, but a) a staff member can hold the backboard with a foot on the base or b)  fill with water to make it easier to move / store when not in use.

2.  The set comes with a ball, but these are usually light weight and more of a playground ball than a true basketball.  More realism will be gained by purchasing several mini-basketballs which fit these goals.  These can usually be found on-line or at stores such as Dick’s Sporting Goods.

Several buildings found mini-basketballs with local school logos and purchased balls for competing schools (e.g. Florida & Florida State, or Tennessee, Kentucky & Vanderbilt).  They found that allowing their resident teams to use these balls gave their teams identity and heightened competition.  Ideally, the facility should have at least 3 balls for each team to speed up the game.

3.  Five straight-back chairs placed in a semi-circle in front of the goal, plus 10 chairs for the “bench” (players not currently shooting) and chairs for spectators.  The spread of the arc can be adjusted to fit the dimensions of the room, but the center seat should generally be placed no less than 5, nor more than 8, feet from the goal, with the others spread to the side accordingly.  At least initially, the “court” should be designed to facilitate scoring.  Creating a sense of accomplishment for the first contestants will encourage greater future participation.

4.  A flip chart on an easel with marker to keep score.  Both individual and team scores will need to be maintained.  A volunteer will be needed to serve as the Scorekeeper.

NOTE:  Tech-savvy communities may find it advantageous to use a laptop and flat-screen TV for keeping SCORE!

Preparation:

Set-up can be accomplished in about 15 minutes once the goal has been assembled.  The activity is suitable for on-going competition throughout the year, but initiating the program during the NCAA tournament adds the additional “spice” to encourage greater participation, selection of TEAM names, etc.  Some buildings may want to encourage residents to purchase TEAM t-shirts/jerseys for additional authenticity to the competition.

Tournament Play:

The style of the tournament will depend on the number of teams involved, recognizing that the principal objective is to generate as much resident participation as possible.  The following options may generate activity programming over several days and/or weeks:

  • Two Teams: Direct head-to-head competition.  This can follow the simple one-and-done philosophy of the NCAA OR utilize the series approach with the best out of 3 or 5 declared the overall winner.
  • Three Teams: Round-Robin competition with each team playing each other team.  If one team beats both the other teams, they will be declared the winner with the team winning the other game as the runner-up.  If each team wins one game, a final round will be held.  If there is no champion determined after that round, the three teams will compete in a sudden death Tie Breaker as outlined below.
  • Four or more Teams: Olympic style competition. Each team will play every other team in a preliminary round.  Then the two teams with the best records will play in a championship round for gold and silver medals.  If desired, the 3rd and 4th placed teams may play in a consolation round for a bronze medal.

ICE-BREAKER IDEA

Demonstration Event

5 Resident Volunteers

vs

THE STAFF

Beginning Play:

Each team will choose a Captain who will also be the first shooter.  After the ceremonial coin toss, the winner will take the middle seat and the first half will commence.

Play:

  1. The first player will shoot 3 balls from the center seat with 2 points scored for each basket made.
  2. The player will then move to the next seat to the right of the basket and the first player from the opposing team will take his/her place in the first seat.
  3. That player will take their 3 shots and then move to the next seat to the left of the basket.
  4. Play then returns to the first player who shoots 3 times and then moves to the chair on the far right.
  5. The first player from the opposing team does the same to the left of the basket.
  6. Then, the 2nd player from the first team moves to the center seat and takes their 3 shots.
  7. As they move to the second seat, the opposing team’s 2nd player takes over the center seat.
  8. Next, the 1st players take their shots from the far seats and then return to the Bench.
  9. This process continues until all 5 players from each TEAM have completed their 9 shots and the FIRST HALF concludes.
  10. After an intermission, the SECOND HALF continues in the same process, except that the first team moves to the left of the basket and the other team moves to the right.  At the end of the SECOND HALF, each player will have attempted 6 shots from the center seat and 3 from each of the other seats.
  11. At the end of the game, the TEAM with the most points (made baskets) is declared the winner.

Tie-Breaker:

In the event of a tie, the player from each TEAM with the highest personal score will be involved in a tie-breaker.  If more than one player on the same team has the same score, the team will choose which one will participate in the tie-breaker.

Beginning with the losing team of the original Coin Toss, the player will sit in the center seat (the “foul shot” position) and continue shooting until they miss.  The opposing team player must then beat the number of shots made by the first player to be declared the winner.

In the event of another tie, play will move to the 2nd highest scorer for each team and continue until a) a winner is chosen or b) all players have participated.

Should that happen, the foul shot line will be moved backwards in 1 foot increments until a winner is determined.

Advanced Play Options:

  1. A more complex scoring option is to record 1 point for baskets from the center seat (equating to a foul shot), 2 points from the middle seat and 3 points from the furthest chair.  It is generally best to begin with the simpler form of scoring until the participants become acquainted with the game and it becomes advantageous to increase the level of competition.
  2. Seats can be placed further away from the goal.
  3. Schedule an on-going competition or tournament with one or more nearby facilities.

    MARKETING TIP:

    • Contact a Senior Citizens Center, Church Group or other Seniors’ Organization and invite them to put together a team to challenge your in-house CHAMPS!

    • Add a social event, door prizes, etc. to tie in with the tournament and add participants and observers to your prospect list.

    Set up a home-and-away schedule with residents traveling to the opposing teams’ home court and vice versa.  Note: this is a great option when the same company has more than one property in the same geographical area – but may, in some instances, be also possible with competitor locations.


[1] These individuals should check out the popularity of women’s college basketball and Tennessee coach Pat Summitt who leads ALL COACHES in total career wins.

[2] Check out “Turning Residents into our Best Marketers” in the CATEGORIES drop-down box for additional thoughts on this philosophy.

Please leave a comment and share the March Madness activities you have implemented successfully in your building.

“Do not go gentle into that good night”

- Dylan Thomas

 

In the 1920’s, T.S. Eliot ended “The Hollow Men” with:

This is the way the world ends
  Not with a bang but a whimper.”

This became a philosophy of aging for 20th Century generations.  The senior living / care industry offered protective living environments to meet the expectations of these generations as they aged with increasing physical and/or mental frailties.

BUT the 21st Century is a different world and the bobby-soxers (born 1935 – 1945) and baby-boomers won’t be satisfied to simply fade into the sunsetas their parents and grandparents did.  They won’t “go gentle into that good night” and the senior living industry must evolve to meet the increased demands of these future generations.

Today’s senior living communities were designed to provide care and services for “The Greatest Generation[1]and/or their parents.  These individuals lived through the Great Depression and were molded by the experiences of World War II.  They worked hard and made a better life for their children who often became the first in their family to attend college.  Frequently, they worked for the same companies their entire career and were rewarded with generous retirement packages, including lifetime health benefits.  Others built their own businesses, anticipating that their children would join and then succeed them in operating the company.  In either scenario, the parents were expected to retire with their productivity and significant contributions to society at an end.

The general message from the adult children and even the government has been:

You’ve done enough.  Just sit back and let us take care of you.

Medicare and related programs in the mid-1960’s created the funding for the development of modern health services to “insure” adequate care for these elderly.  Nursing homes and home health evolved from cottage businesses into professionally managed multi-million dollar industries.   Assisted living, independent living and investor owned CCRC’s developed to supplement non-profit (primarily church-related) life care communities and traditional “old folks” homes.

Operators built self-contained communities and assured residents that all their needs could be handled within these enclaves.  Food and shelter, security and transportation for essentials such as doctor appointments[2] were provided.  Activity programs were scheduled to entertain and fill the residents’ days.

Today, prospective residents are told that their worries will be over if they agree to move-in and pay an all-inclusive fee.  Concerns about meals, cleaning and maintaining the house and yard, or paying insurance and utilities, etc. are eliminated.  Depending on the type of facility, care needs may be provided directly by facility staff or arranged with private caregivers / home health companies.

This comprehensive approach led one resident in a recent Tennessean article[3]tostate: “They really take good care of me here. . .  They do everything for you.  They would even make my bed if I wanted them to, but I said ‘No, I want to do something.’”

Progressive Dependency

This chart demonstrates the loss of independence and increasing dependence on caregivers as the senior progresses through varying levels of care.

For individuals who experienced the shortages and deprivations of the Depression and World War II, the value equation was fairly simple.     They understood that the move to a senior living community was a compromise as their health and support needs increased.  They were used to adapting so giving up some independence to receive service was an acceptable alternative and they were willing to live with restrictions such as standard meals at set times.

However, these generations are dwindling – e.g. World War II veterans are dying at the rate of 1000 per day. [4] The replacement generations do not appear as willing to accept this one-size-fits-all-mentality.

The industry has seen quarterly declines in average occupancy for more than 2 years with blame placed largely on the economy and specifically the real estate market.  It’s time for a wake-up call if the industry wants to rebound from this census slump.  Another hidden (or ignored) factor is the “changing of the guard” with new demand models and demographics for today’s aging population.

There currently seems to be an over-riding preference for “Aging in Place”.  The Tennessean[5] states: “Despite more alternatives than ever, the overwhelming majority of elder Americans choose to age in place — in their own home, within the communities where they have lived for decades or have family ties.”

At some stage in the aging process, however, staying at home may NOT be the best option. Health and care needs, financial considerations, safety concerns, marital situation, housing condition, proximity of family members and the availability of caregivers and other components of a strong support system are factors that will impact this evaluation.

Yet, many senior specialists[6] note that the elderly will often stay in their own home until a “crisis” arises.  As a result, the senior is often “placed” in a higher level-of-care than required, with an unneeded loss of independence.

This is obviously not the best for the resident.  Could a senior living community do something differently to encourage the individual to move in earlier?

First, recognize that today’s aging population demands more than three meals a day and the “3-B’s activity program” – i.e. bingo, bible and birthdays.  They are not willing to retire their egos when they stop working.  They desire many more active and productive years with the ability to control their own destiny.

Focus on lifestyle vs real estate.  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”.[7] It takes more than living in a Taj Mahal to generate enough value to prompt a move-in.

Apply a scientific approach to the structure and organization of daily activities for the residents.  Utilize Maslow’s theory and healthy aging concepts to challenge the residents to continue to age gracefully, achieve new successes and “CREATE PRECIOUS MEMORIES”.  Treat the residents with dignity and respect by developing imaginative programs that stimulate and challenge their mind, body and spirit, going beyond the kindergarten style Summer Camp for Seniors[8] or cruise ship mentality.

Become familiar with the research about the negative impact isolation has on aging and couple this with Maslow’s need for socialization to develop a powerful marketing tool – offering a SOLUTION for potential residents and, especially, their adult children.

Revise marketing strategies to include education about your scientific approach and other 21st Century initiatives.  Use these to differentiate your community from the competition, AND eliminate prior perceptions.

Train staff to PROMOTE INDEPENDENCE by “helping” residents with their activities of daily living, but not “doing it for them!”  A former resident related an incident where she was made to feel “helpless and incapable” because, at an outing, “everyone tried to get food for me as if I couldn’t do things for myself.”[9]

Finally, accept that the new generation is guided by the words of Dylan Thomas:

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.


[1]Tom Brokaw, 1998.

[2] Maslow refers to these as “basic” needs in his Hierarchy of Needs.  Select “Maslow” in the CATEGORIES drop-down box to access additional articles dealing with differing levels of needs.

[3] “Facilities offer convenience and care” by Jessica Bliss, 12/27/2009.

[4] Associated Press, May 24, 2008

[5] “Elderly forgo assisted living – opt to stay at home” by Jessica Bliss, 12/27/2009

[6] Click on this link to review comments posted in the Senior Care Services Companies group on LinkedIN.

[7] Courtesy of Jason Popko.

[8] By Ellen Brandt, Ph.D., August 1, 2009 on the Ellen Interactive blog.

[9] Essay by Betty Warren, Hickory, NC, 2006

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