“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

Beyond “DEATH and Dying” – Part 2

Moving Past Denial

One of the common mistakes in grief management is not allowing feelings of DENIAL. This is often demonstrated by relatives attempting to force the individual who has suffered a loss to “face reality” and move on with their life.   Yet, Dr. Elisabeth Kubler-Ross in her renowned book “On Death and Dying” states that initial denial is an important temporary defense and serves “as a buffer after unexpected shocking news”.[1] She  goes on to suggest that this defense mechanism is necessary to allow the individual adequate time to adjust to their loss and notes that it may be combined with a tendency towards isolation – wanting to be “left alone”.  Family and other caregivers should understand that this is part of a healthy grieving process. [2]

This knowledge impacts the senior living industry because move-ins are a PROCESS more than an EVENT.  An individual in denial is unlikely to recognize the value of a move-in at this stage.  At the same time, it would be a mistake to write them off from marketing efforts:

  • They became a prospect when they demonstrated interest in the senior living community.  Although you may not know their particular “need”, BUILDING A RELATIONSHIP will move towards an ultimate move-in.
  • Most aging adults are constantly dealing with some form of loss.  A move-in will occur when the senior perceives more value in the lifestyle offered by the community than in their existing situation.  This process takes time.
  • Previously, it took 8 – 9 prospects per unit to fill an independent living community.  With today’s economy, those numbers have almost doubled to 15+ per unit.
  • By maintaining communication and social interaction, management may help the person move beyond the denial stage.  Dr. Kubler-Ross states that people may be selective in choosing which individuals to whom they communicate feelings of denial.  In practice, they may be more open to discussing future plans with the manager/marketer than with their own family members.

The first step in recognizing the denial stage is on-going conversation to learn what losses the senior has experienced (See Part 1 for examples).  This requires an investment of personal time and energy in each relationship – it won’t happen by simply inviting prospects to Special Events and/or calling every 6 months.

The marketing strategy for this stage is DON’T PUSH!  Long term success is more likely by simply “making a friend”, being positive and understanding that it’s part of the process if your overtures are initially rejected.  Be subtle when communicating the benefits of your community.  In time, these may be seen as positive alternatives to the prospect’s current situation and help in their acceptance of their loss – but it can’t be forced!

Liz’s CASE STUDY will help illustrate these points:  She is 85 years old and a widow for 5 years.  She now lives alone with her cat in her home of 20 years.

Liz is in reasonably good health but suffers from arthritis with several knee and shoulder surgeries in the past few years.  She has limited mobility, using a cane for walking any distance.  She continues to drive (around town only) and remains active with her church.

Anne, Liz’s adult daughter, recently stopped by and expressed concern about her mother’s ability to keep up with her house.  Although Liz has a cleaning lady, a lawn service and a handyman when needed, Anne is concerned that the house and yard are more than “Mom” can handle.  Liz has great friends that help out but they are getting older and have their own health issues.  Anne explained that she works and lives out-of-state.  She is finding it increasing difficult to visit and help with things around the house.

Liz has been upset because she wasn’t able to put up her Christmas tree.  Unlike past years, Anne was unable to visit and handle it this year.  So now, Anne has come to you for help – what do you do?

Obviously, the first step is to meet Liz.  Since this is apparently her daughter’s idea, you can expect some resistance.  A traditional way to become acquainted with Liz is by inviting her to a Special Event, but a more intimate approach may be to invite Anne and her mother for a personal visit, including a meal and/or participation in a planned group activity.

The objective of this first meeting should be to initiate a relationship.  During that process, you will identify various walls that Liz has erected as reasons why she can’t move in.  Some of these barriers are a result of the DENIAL of her current situation, while others are related to pre-conceived notions about senior living communities.  These apprehensions may be caused by outdated perceptions of “old-folks” homes or past experience with other levels of care such as nursing homes.

You will need to overcome these barriers, but in the initial stage, it is best to simply educate the prospective resident and her family.  Speak of your efforts to PROMOTE INDEPENDENCE, insure privacy and treat all residents with dignity and respect.  Focus on what the resident “can do” vs the “cannots”.  Utilize the information you’ve gathered to address specifics (e.g. Liz’s pet cat) before they become issues.

Make a follow-up in-home visit with Liz after Anne has departed.  Liz will probably be feeling a little lonely and welcome the visit, which should generate a wealth of information about her current situation.

Finally, here’s a word of caution.  It is very tempting to “gang-up” with Anne and coerce Liz into a premature move-in.  Yes, this might assuage Anne’s guilt feelings, but remember that the customer is Liz – not her daughter.  She won’t become a happy and satisfied resident until she moves past denial.


[1] “On Death and Dying”, Elisabeth Kubler-Ross, M.D., 1969

[2] NOTE:  An extreme or extended denial phase must be treated by professionals.