Assisted Living Executive Sept 2005

Transcription

VOL.12. NO.7
, SEPTEMBER 2005
AssistedEXECUTIVE
Living
SMART
Technology
Business
SMARTER
OPERATIONS S0FTWARE
PACKAGES LET EXECS
CHART REAL-TIME METRICS
WHEREVER THEY ARE
GROWTH STRATEGIES
Why Monetize
Real Estate Assets?
COMMUNITY SYSTEMS/
INFRASTRUCTURE
Innovations in
New Building
SPECIAL REPORT
Technologies
Residents Want
THE BUSINESS MAGAZINE OF ALFA: THE ASSISTED LIVING FEDERATION OF AMERICA
YARDI Senior Housing
Comprehensive Senior Housing Management Software
Independent Living,
Assisted Living,
& Dementia Care
Fully Integrated, Browser-Based Technology
Complete Accounting Functionality
Prospect Lead Tracking
Resident Billing and Census
Third-Party Billing
Customizable Assessments
Care Plans
Scheduling
www.yardi.com
Yardi Systems, Inc.
430 S. Fairview Ave. Goleta, CA 93117
800.866.1144
Pass Meds. Not Errors.
Pass Meds. Not Errors.
Does your system catch errors
before they happen?
Does your system catch errors
before they happen?
Multi-Dose and
Unit Dose
Systems
Available!
All OPUS med pass systems do! For any particular resident, for any particular time of day or for any particular medication . . . the OPUS Unit Dose or Multi Dose
points
youdoes!
to theFor
only
pillsresident,
to give. That’s
The OPUSSystem
med pass
system
anycorrect
particular
for anypowerful
partic- assistance and control for
your caregivers. When you choose a pharmacy that provides an OPUSmed pass system, you
ular time of day or for any particular medication . . . the OPUS system
are doing everything possible you can to prevent errors before they occur. Each resident’s
points you to the only correct pill to give. That’s powerful assistance and
meds are pre-loaded by the pharmacist in an individual color-coded, tamper-evident cassette.
control for your caregivers. When you choose a pharmacy that uses the
This assures that the right person gets the right meds at the right time. Peace of mind
OPUS medispass
you are
doingofeverything
you can
to preone system,
of the many
benefits
the OPUSpossible
system—the
only
syste m with eight
beforeorthey
occur.
Each
resident’
s
meds
are
pre-loaded
by
the facility
vent errorsvisual
audible safety checks built right in. If you think your
pharmacistmight
in an be
individual
This
ready tocolor-coded,
move up to atamper-evident
more efficient,cassette.
safer, and
more
assures thatsecure
the right
person
gets
the
right
med
at
med pass system, give us a call.
the right time. Peace of mind is one of the many
benefits of the OPUS system—the only system
with eight visual or audible safety checks
built right For
in. Ifmore
you think
your facility
information
on the OPUS med pass system, call
1-800-228-5021,
ext.
120, or
visit opusmedsystems.com.
might be ready
to move up to
a more
effiset upsecure
a meeting with your current pharmacy or introduce an OPUS provider to you.
cient, safer,We’ll
and more
med pass system, give us a call.
For more information on the OPUS med pass system, call 1-800-228-5021,
ext. 120, or visit www.opusmedsystems.com. We’ll set up a meeting with
your current pharmacy or introduce an OPUS provider to you.
Simple. Sa fe. Secure.
OPUS Medication Systems is a member of the President’s Council of The Assisted Living Federation of America (ALFA}
Simple. Safe. Secure.
SEPTEMBER 2005
AssistedEXECUTIVE
Living
ADVANCING EXCELLENCE IN
A S S I S T E D L I V I N G O P E R AT I O N S & C A R E
Formerly Assisted Living Today
, VOL. 12, NO. 7
Contents
FEATURES
12 COVER STORY
Smart Technology, Smarter Business
BY ANYA MARTIN
A new generation of operational software packages is helping assisted living
executives chart and compare a wide variety of metrics in real time. Includes
the annual list of operations software providers.
18 GROWTH STRATEGIES
Rethinking Real Estate Assets
BY RAYMOND J. LEWIS
By selling off their real estate assets, senior housing providers are freeing
up capital to be used elsewhere, such as redeployment into higher-returning
opportunities needed to grow the business.
12
23 GROWTH STRATEGIES
On a Roll? BY ADAM STONE
Strong second-quarter numbers for assisted living indicate a business whose
star is clearly on the rise, say insiders.
26 COMMUNITY SYSTEMS/INFRASTRUCTURE
Building Excitement BY ANYA MARTIN
Companies that have recently built from the ground up are unveiling exciting
new models that blend seamlessly into their landscapes, both urban and elsewhere. Units also are bigger and incorporate lots of natural light and green space.
31 SPECIAL REPORT
Resident-Focused Technologies
23
BY JIM MOORE
Are you missing a major opportunity to offer high-tech solutions to enhance
residents’ quality of life? Several ideas are offered here—from voice-recognition
technology to Webcams to special TV channels for residents.
DEPARTMENTS
5
6
9
35
31
37
TOP OF MIND
BY RICHARD P. GRIMES,
40
ALFA President and CEO
41
EXEC TO EXEC
Insights on today’s issues
NEED TO KNOW
Industry updates and ALFA news
COMPLIANCE CORNER
BY LORETTA LEBAR & KEITH MAURER
AFFILIATE SPOTLIGHT: TALA
BY BECKY SQUIRES & SKIP COMSIA
42
43
44
CONSUMER VOICE
On aging and independence
RESOURCE LINK
Classified ads
PEOPLE & PLACES
Appointments and developments
AD INDEX
Guide to advertisers in this issue
PRODUCTS & RESOURCES
Assisted living solutions
Assisted Living EXECUTIVE
, SEPTEMBER 2005
3
TIRED OF THE JUGGLING ACT?
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REPS Suite’s affordable, flexible pricing plans. Call us today to find out how REPS Suite can
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813.935.4465
Executive Publisher
Richard P. Grimes, ALFA President/CEO
Publisher
Debra J. Stratton
Editor/Associate Publisher
Angela Hickman Brady
Associate Editor
Marlene L. Hendrickson
Contributing Writers
Anya Martin, Whitney Redding, Adam Stone
Art Director
Becky McClimans
PUBLISHING OFFICES
Stratton Publishing & Marketing Inc.
5285 Shawnee Road, Suite 510
Alexandria, VA 22312
703/914-9200; fax 703/914-6777
E-mail: [email protected]
For circulation information, call 703/691-8100.
A D V E RT I S I N G S A L E S T E A M
Alison Bashian, [email protected]
Marianne Juliana, [email protected]
Stratton Publishing & Marketing Inc.
800/335-7500; fax 440/349-3447
Insights and critical review provided by the
A L FA O P E R AT I O N A L E X C E L L E N C E
A D V I S O RY PA N E L
Michel Augsburger, President & CEO,
Chancellor Health Care Inc.
Cindy Chastulik, Divisional VP, Eastern Division,
Alterra Healthcare Corp.
Page Estes, VP of Operations,
CaraVita Senior Care Management Services Inc.
Jill Haselman, SVP, Organizational Development &
Culture, Benchmark Assisted Living
Justin Hutchens, SVP & COO,
Summerville Senior Living
Benjamin R. Johns, VP of Operations,
Carriage Court Communities
Susan Klein, SVP, Brandywine Senior Care
Linda L. Martin, President & COO,
Signature Senior Living
Jack Peters, VP of Operations, Silverado Senior Living
Marla Sovereign, VP of Assisted Living,
American Retirement Corp.
Daniel Schwartz, SVP of Operations,
Sunrise Senior Living
PUBLISHED BY THE ASSISTED LIVING
FEDERATION OF AMERICA, FAIRFAX, VIRGINIA
Assisted Living Executive (ISSN 1553-8281) is published
monthly, with combined issues in January/ February,
July/August, and November/ December, by the Assisted
Living Federation of America, 11200 Waples Mill Road,
Suite 150, Fairfax, VA 22030. Circulated to ALFA
members only; a portion of dues is for subscription.
Periodicals postage paid at Fairfax, VA, and additional
mailing offices.
POSTMASTER: SEND ADDRESS CHANGES TO Assisted
Living Executive, 11200 WAPLES MILL ROAD, STE. 150,
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please contact the Copyright Clearance Center, Customer
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Assisted Living Executive will not be responsible for the
return of any unsolicited manuscripts or photographs.
Serving professionally managed
assisted living communities for
seniors by:
t driving business excellence
t influencing public policy and
t building a more informed public.
ALFA PRESIDENT/CEO
TOP OF MIND
Seeking Answers Together
I
n an essay titled “What Are We Going To Do With Dad?” in
The Washington Post (August 7), a practicing geriatrician
shared his gut-wrenching experience of attempting to care
for his 86-year-old father who suffers from dementia. All of his
professional training and years of experience cannot “fix” all the
challenges he faces. Instead, it is in his role as an agonized and
overwhelmed son that he seeks answers—and effectively
confesses that he just does not have them.
The challenge of planning for long-term care and caring for
aging parents is complicated immensely when dementia is added
to the picture. The recent Alzheimer’s Association Dementia Care Conference
(August 2005) was the largest ever—full of individuals seeking answers in their
professional and personal lives. I was privileged to represent ALFA on a panel
of influential organizations in support of the recently published Alzheimer’s
Association Campaign for Quality Residential Care: Dementia Care Practice
Recommendations for Assisted Living Residences and Nursing Homes.
ALFA made significant contributions to these recommendations and
I spoke in support of their implementation.
Research is starting to objectively quantify what our members already know:
that more than half of all residents living in assisted living demonstrate some form
of dementia—and that the problem is increasing nationwide. ALFA’s participation in
the Alzheimer’s Association effort is entirely aligned with our increased focus on
quality and operational excellence, as well as our continued commitment to share
the knowledge and experience of our members to best serve our residents and
our profession.
In addition to our work with the Alzheimer’s Association, ALFA will release a study
that analyzes state dementia care regulations and policies this fall. The study should
shed some light on the states that model good practices—and those that need more
intervention by coalitions of organizations such as the Alzheimer’s Association
and ALFA. We’re also working with representatives of ALFA’s Clinical/Quality
Executive Roundtable to develop operational practice guidelines on resident
elopement, an issue that resonates with a dementia care population.
Finally, though less directly related to the issue of Alzheimer’s and dementia,
ALFA has entered into a coalition with other relevant organizations (AAHSA,
ASHA, NIC, and NCAL) to survey assisted living providers. In the past, your company
or your residence may have received surveys from several of these organizations
at different times of the year asking many of the same questions. This year, we’re
working together to ensure your company or residence will receive only one survey.
Not only will this reduce the burden on our member companies and individuals,
the result will be the 2006 Overview of Assisted Living: Facts and Trends—
a report for the media, for regulators, for the public, and for you—that represents
assisted living in America as it is today. I urge you to participate when you
receive the survey.
Richard P. Grimes ([email protected])
, SEPTEMBER 2005
5
EXEC TO EXEC
INSIGHTS ON TODAY’S ISSUES—HUMAN RESOURCES
What are your best tips for efficiently and
effectively getting through the background
check process for new hires?
ake sure you have a thorough interview process
in place. Reference checks are
important, too. Depending on the
level of the applicant, the reference checks may be more extensive. For a senior-level hire, check
not only with the people they’ve
worked for but also with people
who have worked for them. One
of my favorite questions to ask
on a reference check is,‘Would
you hire this person back? Why
would you? Why wouldn’t you?’
For background checks,
you’ve got to work with a good
vendor that has the resources to
do the kind of checks that you
need. (Sunrise works with
United States Investigations
Services.) A person’s past is a
very good predictor of future
behavior. It’s not the only thing
you’re looking at, but it is
important. It’s also part of being
a good steward of the business.”
— Jeff Jasnoff (jeff.jasnoff@
sunriseseniorliving.com)
“M
Jeff Jasnoff,
Senior Vice
President of
Human
Resources,
Sunrise
Senior Living,
McLean,Virginia
Heather
Blackburn,
Director of
Human
Resources,
Encore
Senior Living,
Portland, Oregon
Terry Frisby,
Senior Vice
President,
Human
Resources,
Corporate
Compliance
and Culture, American Retirement Corp. (ARC), Brentwood,
Tennessee
or new hires, each of our
communities conducts its
own background checks.
Companywide, though, Encore
Senior Living uses an ‘integrity
test’ from Insights Worldwide
Research. Each community can
administer it on site and it only
takes about 15 minutes; there
are 70 questions. The questions
are designed to get at any potential problems, for example, with
deception, theft, dependability,
and worker’s compensation
“F
6 SEPTEMBER 2005
,
issues.The test identifies ‘cautions’ in these areas.
Applicants can take the test
on a computer or on a handheld PDA—but once you
answer a question it’s designed
so you can’t go back and
change your answer.
We have found this test to be
very effective. It’s been in place
for about three years and in that
time our retention rates have
increased and our turnover has
gone down.”—Heather
Blackburn (heather.black
[email protected])
e set our own requirements for background
checks that meet or exceed
requirements in every state.
(ARC works with United States
Investigations Services.) We also
have several packages we use
for background checks, depend-
“W
ing on the position you’re in.
For example, the background
check for the driver of the van
for a community will include
looking at Division of Motor
Vehicles records, whereas the
check for the person employed
in the kitchen will not.
Managers at each of our communities will undergo the most
comprehensive background
check package.
USIS provides a broader net
of background searches rather
than just single-state checks.
That is particularly helpful for
hiring people who have moved
from state to state.We want to
make sure that if there is anything in their background, we’re
able to find it. If we have a single value, it is safety and the
quality of care we provide for
our residents.”— Terry Frisby
([email protected])
QUICK TIPS
Keep the following steps in mind when going through the background check process:
Disclosure and Authorization. You must give the individual
investigated a special notice in writing that you will request a consumer or investigative report and obtain his or her signed consent. You must also provide a summary of rights under federal
law. If the individual investigated wants a copy of the report, he or
she may obtain a copy from the consumer reporting agency or, in
California, Minnesota, and Oklahoma, he or she may affirmatively
request a copy by “checking the box” on the disclosure form.
Certification. You must certify to the background check or
investigation company that you will comply with federal and state
laws by signing a form that it will typically provide to you.
Providing Copies and Notice of Adverse Action. You must
provide a copy of the report with a letter to the person investigated
if: the individual has requested a copy in California, Minnesota, or
Oklahoma; an employer in California obtains consumer information
that is a matter of public record; or adverse action is taken based
on information in the report.
Adapted from Background Checks and Investigations of Applicants and Employees: Four Steps
to Basic Compliance With Federal and State Law, Second Edition, published by the Legal Learning
Group, a division of Littler Mendelson, P.C. © 2003 Littler Mendelson. All Rights Reserved.
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How are Assisted Living providers achieving
operational excellence?
Just ask our customers…
We focus on the person rather than the task.
“Personal preference is at the heart of our service philosophy.
Vigilan helps us capture and share information, making it easier
for our staff to serve the individual needs of residents.”
Marge Coalman, Director of Wellness Programs, Touchmark
We eliminated service creep that we didn’t know we had.
“With Vigilan we are better equipped to serve our residents and
support our staff. In our first quarter, our assisted living service
revenue per occupied unit grew by 91 2 percent without adding
assisted living labor.”
Paul Dendy, President, Lifestyles Senior Housing Managers, LLC
We select only the best tools.
“Just like a carpenter needs a good hammer, administrators need
Vigilan. I simply can’t imagine my job without it.”
Megan Lee, Administrator, Bridgewood Rivers Assisted Living
We make it simple. You make it yours.
Vigilan’s operational management system makes it easier for
assisted living facilities to profitably improve their quality of care.
We understand that when it comes to delivering care, your
personal touch makes all the difference, so we have created an
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Request a demo today:
800-443-1127
[email protected]
www.vigilan.com
I N D U S T R Y
U P D AT E S
&
A L F A
N E W S
NEED TO KNOW
Acquisitions Market Heats Up
uggy summer days
are waning throughout the country, but
the acquisitions market in seniors housing continues on its
hot streak.The market
demand for senior care properties is at its strongest since
the mid-1990s and owners of
high-quality portfolios continue to flood the market with
properties.
“I have never seen the
market this active with so
many large portfolios available for sale,” says Stephen
M
Monroe, a partner in the
investment research firm
Irving Levin Associates Inc . In
June, the firm released The
Blue Light Therapy Helps Seniors Sleep
A recent pilot study by the
Lighting Research Center (LRC)
in Troy, New York, has concluded that exposure to blue light
may reduce sleep disturbances
and increase the likelihood of
stable sleep in seniors.The
study included seniors with
Alzheimer’s as well as seniors
without dementia who have
trouble sleeping.
“Physical changes to the eye,
neural changes in the brain, and
lifestyle changes can mute the
light/dark signal sent to the
body’s master clock, presumably contributing to major sleep
disturbances in seniors,” says
Mariana Figueiro Ph.D.,
LRC director, and coprincipal investigator
for the study. LRC
researchers have found
that exposure to blue
light can efficiently
and effectively stimulate the body’s circadian system, create a
light/dark pattern the
body can recognize
and react to, and influence normal sleep
cycles.
For more about
the blue light therapy
study, visit LRC online
at www.lrc.rpi.edu.
Health Care M&A Report,
which examines mergers and
acquisitions in the senior
care market for 2004 and the
first part of this year.
“The strong senior care
acquisition market has continued, especially in the assisted
living and independent living
sectors,” Monroe says.“A few
years ago, per-unit prices of
$200,000 were uncommon, but
now we are heading toward
$300,000 in a few cases.”
More than 50 publicly
announced senior care property or company acquisitions
took place in the first half of
2005, compared with 34 in
the first half of 2004. In addition to a jump in the number
of mergers and acquisitions,
more of this year’s transactions have carried larger price
tags. By the end of the second
quarter this year, there had
been six acquisitions valued
at more than $100 million
each, compared with three
acquisitions valued at that
much last year.
™
National Assisted Living Week
he theme for this year’s National Assisted Living Week
(NALW) is “A Fair to Remember,” encouraging assisted
living communities across the country to celebrate by holding special events that harken back to the local fairs of the
past—complete with blue ribbon bake-offs, petting zoos, and
parades.The week begins on September 11 (Grandparents’
Day) and runs through September 17.
An annual event supported by the Assisted Living
Federation of America (ALFA) and other organizations, NALW
highlights the important role assisted living communities play
in helping the nation’s seniors live as independently as possible while enjoying a meaningful quality of life.
To download free NALW materials, including a planning
guide, media advisory, and logo, go to www.nalw.org.
T
Logo created by the National Center for Assisted Living.
, SEPTEMBER 2005
9
NEED TO KNOW
Government Relations Update
Medicaid To Cover Assisted
Living in Ohio
The new two-year state budget will allow
seniors in Ohio to use funds they receive
from the state-federal Medicaid program to
pay for assisted living services. On July 1,
2006, about 1,800 individuals who currently
receive Medicaid benefits will be eligible
for the Assisted Living Medicaid Waiver
Program, which will pay for services only—
not room and board.
“We are thrilled that this has passed.We
feel it will be successful,” says Jean
Thompson, executive director of the Ohio
Assisted Living Association (OALA).
“Once it is proven to be successful in this
two-year budget period, we are hopeful that
the number of slots will be increased. It’s a
good start.”
Thompson says the OALA does not
expect “a great deal of new regulation” to
10 SEPTEMBER 2005
,
Legislators and Department of Aging officials “are keenly aware that if they drown
this in additional paperwork and regulation,
communities will not opt to participate,”
Thompson adds.“I’m sure there will be
changes at some levels, but we don’t anticipate major regulatory changes.”
Louisiana Amendment
Addresses Assisted Living
accompany the program, particularly since
it is voluntary. All licensed residential care
communities in the state can apply to be
providers under the new Assisted Living
Medicaid Waiver Program, which will be
directed by the Ohio Department of Aging.
An amendment approved by the Louisiana
legislature in the session’s final hours could
dramatically impact assisted living care in
the state by allowing nursing home owners
to convert licensed beds to assisted living
units that can service private pay or
Medicaid residents.The ALFA state affiliate
and ALFA National Office both opposed the
measure.The amendment was an add-on to
a bill imposing a moratorium on nursing
home construction.
The amendment’s sponsor, Sen. Joe
McPherson, chair of the state Senate’s
Health and Welfare Committee, vice chair of
Appropriations, and a nursing home owner,
claimed the amendment would save state
Medicaid dollars and address nursing home
occupancy issues.
Converted assisted living units will be
licensed under a different agency than
other assisted living—the Department of
Health and Hospitals (DHH)—and will be
permitted to offer different services, such as
medication administration.The amendment
may place assisted living facilities at a competitive disadvantage, since it is unclear
whether they will be allowed to offer the
additional services, like medication administration, even if they agree to supervision
under DHH.
ALFA and the Louisiana Assisted Living
Association continue work to ensure regulations promulgated as a result of the
amendment guarantee a level playing field
for all assisted living providers.
often comes from the family,ALFA’s Paul
Williams told the Times, “but forward-thinking operators are receptive.They know the
reluctance of most people moving in, and
this builds good will.” For more about the
Times article, e-mail [email protected].
■ An ABC News online article—“Many
JoltedMF_AsstLvng_ALE
by Cost of Long-Term
Elderly Care”—
2/7/05
9:31 AM
reported that roughly 9 million elderly
Americans currently require some kind of
long-term care. By 2020, that number will
jump to 12 million.
The article also reported that four in
10 Americans don’t know what steps to
take to prepare for their own long-term
care, according to a recent study. For
more
this ABC News report, go
Page about
1
to www.abcnews.com. ▼
SAVE TIME, ENERGY AND
MONEY WITH OUR
TOTAL APPLIANCE SOLUTION.
AIA Includes Assisted Living
Design Guidelines
The 2006 Guidelines for Design and
Construction of Hospitals and Health Care
Facilities manual, issued by the American
Institute of Architects (AIA), will include a
new section on assisted living residences.
ALFA has participated throughout AIA’s
two-year drafting process for the manual
and provided input regarding proposed
amendments in the assisted living section.
A spokesperson for AIA says the manual
is scheduled for release next spring and will
be available for purchase at www.aia.org/
store.The price will be around $75, which
is what previous editions of the manual
have cost.
Assisted Living in the News
The New York Times in July reported on
the decision-making process seniors and
their families go through when considering
housing options, such as assisted living. In
an article by reporter Jane Gross—“TestDriving a Retirement Community (Yes,You
Can)”—the paper reported that temporary
stays in assisted living communities to “kick
the tires” are a valuable option for prospective assisted living residents, as well as for
family caregivers in need of respite care.
The initiative to ask for a temporary stay
■
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, SEPTEMBER 2005
11
COMMUNITY SYSTEMS/INFRASTRUCTURE
Smart TECHNOLOGY,
Operational software
revolutionizes assisted living
with real-time metrics
available wherever you go
By Anya Martin
s founder and CEO of Portland,
Oregon-based Vigilan Inc.,
Christian Mason (chrism@
vigilan.com) helped develop
The Analyzer, an operational
management portal that
provides a comprehensive picture of current and projected results for multiple
communities. However, when he installed
his new Web-based software into his two
highest performing communities, he immediately learned something he never would
have learned under the old system.
“My top-performing community was 13
assessments behind and the other was 11
behind,” Mason says.“From a regulatory
standpoint, that’s a potential problem. From
a quality standpoint, that’s a potential problem. I immediately got in my car and drove
to each of those buildings to see what was
going on.”
Today, a new generation of operational
software packages is helping assisted living
executives chart and compare a wide variety of metrics in real time, not just identifying problems before they become crises
but allowing providers to take charge of the
bottom line like they never have before.
What’s more, costs have come way down
and it’s likely that one program or a suite of
complementary ones can integrate billing
with marketing, staff scheduling with service
plans, and census with resident satisfaction.
A
REAL-TIME METRICS
Fifteen years ago, every individual assisted
living community had its software programs
loaded manually onto one or more PCs,
12 SEPTEMBER 2005
,
with no real-time connection even among
residences that shared the same operator,
recalls Lance Raab ([email protected]),
president and CEO of Tampa-based Ideal
Software Inc. Today if a sales manager is
snowed in at home, he can log onto the
Internet, access his database of leads, and
make sales calls. Or a CEO can consult his
laptop, or even his PDA, at the airport and
see a dashboard of real-time metrics ranging
from census to staff turnover across every
community in the company.
“The days of having isolated areas for
PCs is rapidly fading away, while the idea of
blending technology into the caregiver
environment is gaining ground in some revolutionary ways,” says Bill Caldwell
([email protected]), president
and CEO of Jackson, Mississippi-based
American HealthTech Inc. During more
than 30 years in the senior living industry,
Caldwell has watched information technolo-
gy go from bulky mainframes to a technology explosion that transcends the basics of
Web enablement.“I think we see a ready
parallel in the way personal communications devices have grown in recent years
from beepers to true personal assistants
that combine telephone and real-time e-mail
service in the same device.”
The Internet, PDAs, and wireless technology have been around for a while, so why
are these products coming of age now in
assisted living? It took longer in part
because the market, made up of people
with health-care and real estate backgrounds, overall was one of late and reluctant adopters of technology, says Paul
Budak ([email protected]), president and CEO of Kirkland,Washingtonbased Point of CareWare Inc.“For the late
adopter market, the value has to be there,
and ease of use has to be there.”
As software has become more user-
Smarter BUSINESS
friendly, assisted living’s need to manipulate
large amounts of data also has increased, with
higher-acuity residents, increased regulations
and liability concerns, high staff turnover, and
resident and family expectations for even
higher levels of service, Mason says. On the
other hand, the answers executives need
now are evolving as this young model grows
up, says Rita Burgett ([email protected]),
president of Bedford,Texas-based Move-N
Software Inc. “Historically people looked for
software that helped increase their census
because they needed to build their population. What people are looking for now is
software that increases their revenues and
enhances their operations.”
Or as Doug Fullaway (dougf@vigilan.
com), Vigilan’s president and CEO, puts it,
now that cash flow is the main issue,“CEOs
no longer want to wait until the end of the
month.They tell us that [they] can’t stay on
top of problems if [they] don’t know what
happened.”
Indeed,Vigilan got the idea for the
Analyzer from quizzing vice presidents of
operations and other key executives about
their day-to-day worries. One of those problems has been knowing what census really
is in multiple communities at any given
moment, he adds.Another is the integrity
of the data.According to Fullaway, a typical
complaint might go like this:“It takes a couple of days to get the data in, and once I see
it in my accounting system and my marketing system, it doesn’t match.”
What are the benefits of software that
charts census, the number of notices to
vacate, and scheduled move-ins yesterday,
today, and tomorrow? If managers see a
drop-off in studios in one community happening day by day, they can respond much
sooner and send marketing right away to
go shop the competition to see if they’ve
dropped their fees, Fullaway says.The same
thing could apply to employee turnover.
Have competitors raised their hourly rates?
Truly integrated, real-time operational
software also can help identify cost-creep,
“Being able to
compare the
seven buildings
within my own
company to the bigger world
would be great.”
Joan Hyde Ph.D., Hearthstone Alzheimer Care
Mason says. For example, a resident may
be being billed $500 a month for services,
but when the services received are tracked,
data reveals that the person is receiving
an extra $100 of services that aren’t being
reflected in their service plans and thus
not being billed.
In sum, real-time metrics lead to executives asking questions they’ve never asked
before, Fullaway says.“It’s very interesting
to see what happens after they’ve installed
the Analyzer,” he adds.“We get phone calls
from operations asking,‘Is that 15 hours
delivered by nurses normal or is that a little
high?’They have a burning desire to compare [their stats] with others.”
Web-based applications have made it
possible to access data quicker and anywhere, but this change has even more ramifications.As noted previously, in years past,
software had to be installed on multiple
individual computers. This task had to be
done most likely by an IT expert, and operators purchased expensive licensing fees,
Raab says. Now, many companies are
uploading the client’s software once online
and charging a subscription rate.The other
benefit is the ability to install updates seamlessly and invisibly to one location, making
deployment even cheaper.
COMPARING SOLUTIONS
When choosing operational software,
consider products specifically developed
for assisted living and its needs, recommends Burgett.When assisted living first
emerged as a model, software providers for
the nursing care industry just tried to
remarket their products, but nursing home
software was built to fill very different
needs such as government-mandated electronic care plans and accommodating the
codes needed for Medicare and Medicaid.
Assisted living, in contrast, is predominantly
private pay and service-oriented.
Beyond that, the most important factor
to consider when buying a new operational
software package is what you need it to do
and who needs access to the data, and that
means being specific, Burgett adds. A vendor may claim it can do a wide variety of
tasks, but if it can’t perform the ones you
need in the way you need it to do them,
then it’s a waste of time and money.
Burgett cites an on-the-surface simple
billing issue,“A lot of companies will say
we want our communities to do the billing
themselves. However, they want to access
everything from the corporate office and
want the corporate office to collect payment and then document that record for
the communities.This means both have to
have real-time access to software.”
After you’ve queried about a program’s
capabilities,“say, show me how,” Burgett
adds.“Have them actually take you through
the process and then see for yourself how
simple or complicated it is.”
If the software doesn’t let you do what
you need, can it be adapted to do so? On
the other hand, if a vendor is willing to
customize, make sure that vendor has the
resources to do so, Budak says.“If a vendor
says, we’ll do anything you want, sometimes
that doesn’t result in the best vendor
because they wind up trying to solve everybody’s individual problems.You also wind
up with not one product but a different
one for every customer, which isn’t necessarily the best thing for everyone.”
Another pitfall to avoid is being blinded
by the “wow” factor, Caldwell says.“The
, SEPTEMBER 2005
13
S O F T WA R E F O R A S S I S T E D L I V I N G O P E R AT I O N S
he following list, compiled by Assisted Living Executive staff, includes only providers of software used in assisted living management, operations, and
marketing. Life safety solutions will be included in the October issue. Every effort was made to include all providers in the market; however, providers
who did not respond to our requests for information are not included here. Companies in BOLD type are members of ALFA.
T
COMPANY
CITY, STATE
CONTACT FOR SALES – PHONE NUMBER
WEB SITE
Achieve Healthcare Technologies
Eden Prairie, MN
Tim Moore – 800/869-1322 ext. 9791
www.achievehealthcare.com
ADL Data Systems Inc.
Dobbs Ferry, NY
Wayne Jobe – 800/965-7475 ext. 231
www.adldata.com
(Optimum Series Clinical and Financial Suite)
A.L. Wizard
San Diego, CA
858/457-0566
www.alwizard.com
American Computer Software
Madison, WI
Heather Gullickson – 800/527-9449
www.acsoftware.com
American Health Care Software Enterprises Inc.
South Burlington, VT
Irene Wright – 800/336-1776
www.ahconline.com
(Harmony Health Care Management System)
American HealthTech (LTC)
Jackson, MS
Linda Trammell – 800/489-2648 ext. 1051
www.healthtech.net
CaraVita Senior Care Management Inc. (CaraSyst)
Roswell, GA
Beth Cayce – 770/552-9788
www.caravita.com
Cignify Corp.
Atlanta, GA
770/551-1761
www.cignify.com
Compu Might Inc. (Compu Care 2000)
Flushing, NY
Judy Sachs – 718/939-2076
www.compumight.com
Concurro Inc. (Collaborative Care
Palo Alto, CA
Michael Sturm – 650/969-2015
www.concurro.com
Management System)
Creative Solutions Unlimited Inc. (Dextrosity Suite)
Sheffield, IA
Martha Koch – 800/253-7697
www.creativesolutionsunlimited.com
Eldermark Software
Minneapolis, MN
Craig Patnode – 866/809-7600
www.eldermark.com
Health Care Software Inc. (INTERACTANT)
Farmingdale, NJ
Thomas J. Fahey – 800/524-1038
www.hcsinteractant.com
HealthMEDX Inc. (CareMEDX)
Ozark, MO
Leigh Daniels – 877/875-1200
www.healthmedx.com
Hearthstone Alzheimer Care (AlphaPLAN)
Waburn, MA
Joan Hyde Ph.D. – 781/674-2884 ext. 30
www.thehearth.org
Ideal Software Inc. (REPS)
Tampa, FL
David Griffin – 813/935-4465 ext. 2157
www.idealsoft.com
INTRAcare (Vitals)
Wichita, KS
Amy Gillogly – 800/395-0132
www.intracare.com
Keane Care Inc. (VistaKEANE)
Redmond, WA
Jim Ingalls – 800/426-2675
www.keanecare.com
LifeCare Software Solutions Inc. (LifeCare Plus)
Budd Lake, NJ
Lisa Sangastiano – 908/852-7400
www.lifecare.net
LINTECH (COMET)
Fort Lee, NJ
Udi Polonsky – 201/944-3235 ext. 24
www.lintechsoftware.com
Mature Solutions
Cincinnati, OH
513/871-0030
www.maturesolutions.com
MedicaOne Inc.
San Francisco, CA
Michael Whitworth – 650/464-2799
www.medicaone.com
MDI Technologies Inc. (On-Line Advantage)
St. Louis, MO
Tom Kerrigan – 800/552-9846
www.mditech.com
MicroMain Corp.
Austin, TX
Wes Amann – 888/888-1600
www.micromain.com
Winnipeg,
Houston Klassen – 877/231-3836
www.momentumhealthware.com
Smithfield, VA
Bob Adams – 757/357-8701
www.monette.com
Bedford, TX
Jennifer Griffitts – 817/282-7300
www.move-n.com
(Resident Safety and Communications Software)
(MicroMain XM computerized management system)
Momentum Healthware
Manitoba, Canada
Monette Information Systems
(ULTRACare Suite and MORE! Marketing Software)
Move-N Software Inc.
PenSoft (PenSoft Payroll Plus)
Newport News, VA
888/736-7638
www.pensoft.com
Point of CareWare Inc. (AL Suite)
Kirkland, WA
Troy Blackmon – 425/463-3959
www.pointofcareware.com
Proven Solutions Inc.
Atlanta, GA
770/399-1993
www.provensolutions.com
SOS Corp. (HelpCare+)
Liverpool, NY
Sean Garner – 800/432-7672
www.sosc.com
UltraBridge Inc.
Owings Mills, MD
Keith M. Farley – 410/753-9028
www.ultrabridge.com
VCPI
Milwaukee, WI
866/407-6377
www.vcpi.com
Vigilan (The Administrator, Marketing Manager,
Wilsonville, OR
Doug Fullaway – 503/682-8828
www.vigilan.com
Goleta, CA
Bonnie Novella – 800/866-1144 ext. 184
www.yardi.com
The Analyzer, The Scheduler)
Yardi Systems
14 SEPTEMBER 2005
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most common mistake buyers make is
allowing a particular bell-and-whistle feature shown by a sharp salesperson to overly
sway the buying decision.At the end of the
day, the real need is a solid, full-featured
package that can address all your vital business needs.”
Operators should also assess the software publisher itself, Raab says, adding,
“You want to make sure they are committed to the industry and they have viability
long term. Do they have a lot of references,
users in the industry? Do they keep the
product up to date? Are they keeping up
with new technology?”
He suggests a few more questions to ask:
■ How long have they been in business?
■ How many employees do they have?
■ What percentage of the company’s
budget goes into research and development?
■ Do users need to key in data, or does
data just flow into the system?
■ Are there extra fees for technical support, and if yes, are they charged monthly,
per-incident, or how?
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Indeed, assessing ease of use remains the
essential ingredient when it comes to evaluating software.“The biggest problem is getting nurses to feel comfortable with technology,” says Joan Hyde Ph.D. (hyde@
thehearth. org), CEO of Lexington,
Massachusetts-based Hearthstone
Alzheimer Care, developer of AlphaPLAN.
“If they don’t, they aren’t going to use it.”
“We have had people make huge investments and then dump it because people
wouldn’t use it,” Burgett says.
In fact, when selecting new software,
don’t just leave it up to the IT guy, Hyde
says. Instead, she suggests considering who
will be using it and if that’s frontline staff,
involve them on the decision-making team.
“If they pick it out themselves, you’re going
to have a lot more buy-in.”
Consider how a company offers
training, whether in-person,Web-based, or
by other means, and how staff will respond
to the mode, the content, and the delivery,
Raab says.While face-to-face may seem
ideal, he advises providers not to discount
Web-based training as a component.
“Our Web-based training has been
designed to be simple,” he adds.
“The days of
having isolated
areas for PCs is
rapidly fading
away, while the idea of
blending technology into
the caregiver environment
is gaining ground in some
revolutionary ways.”
Bill Caldwell, American HealthTech Inc.
American HealthTech staff work with
management to familiarize themselves
with the old system before developing a
customized knowledge transfer plan specific to that particular new client, Caldwell
says. However, he cautions against a common misconception that “good software
can correct sloppy operations management,” he adds. Instead company-wide training at the time of new software installation
can provide a great opportunity for companies “to challenge their existing business
processes and incorporate training for those
changes in concert.”
Also, don’t forget training doesn’t end
in the first few months of use, he adds.
What if there’s a problem? Will the company still be there for you?
“There was an interesting study by
Deloitte & Touche a couple of years ago,”
Caldwell says.“It compared customer buying motives and how those motives had
changed from their initial purchase of a
system to the second time.Where price
was the No. 1 motivation for the initial
purchase, the majority of second-time
buyers ranked vendor support as their
top buying motive.”
Finally, consider the written documentation that comes with software, whether in
hard copy or posted online, Campbell says.
Must questions for references include
whether it is understandable to lay readers
and up to date.“One additional problem
with hard-copy documentation is that it cannot be context-sensitive,” he adds.“With good
, SEPTEMBER 2005
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Page 1
online help, the system should take you
directly to the relevant section of the text
based upon where you currently are in the
system. Our stance is that hard copy documentation is a developer’s shortcut, and that
it should be a red flag to a buyer that could
signal other shortcuts might be taken at the
expense of the user experience.”
Indeed, when it comes to whether a
company delivers on training and support,
checking references is the only way to get
a true advance picture, Budak says.“In a
market that requires high touch with vendors, the bottom line is,‘Down the road as
my business changes, will my issues get
resolved quickly?’”
FUTURE ADVANCEMENTS
These trends starting now will mature over
the next few years into even more exciting
capabilities, allowing users to do things
faster, more easily, and at steadily lower
costs, most experts agree.
As technology allows more data to be
tracked, the most exciting potential is for
providers to benchmark key stats against
competitors.“Ultimately, when it’s all Webenabled, everybody is going to share data,”
Hyde says.“It’ll just be a matter of making
sure your fields can translate.To me, that’s
the most important thing about software
other than being a repository for information. Being able to compare the seven buildings within my own company to the bigger
world would be great.”
Hyde cites the MASS PEP project as an
example. Members of the Massachusetts
Assisted Living Association, an ALFA affiliate,
all conducted the same customer satisfaction survey and shared their results.To win
over everyone’s trust, Hyde says,“We made
a pact not to compare data in advertising,
but we all knew where we stood. It gave us
not just a way to benchmark ourselves, but
also something to take to regulators.We
could say,‘This is what our consumers are
saying to us,’ which is positive, and ‘Here
are some areas we needed to improve,’
and,‘Here’s what we did.’”
Enter hand-held devices,Web-based, and
wireless technology, and providers will be
able to go far beyond using software just to
track metrics or marketing leads, says Beth
Cayce ([email protected]), CEO of
Roswell, Georgia-based CaraVita Senior
“The bottom line
is, ‘Down the road
as my business
changes, will my
issues get resolved quickly?’”
Paul Budak, Point of CareWare Inc.
Care Management Inc., which operates
18 communities in the southeast and
recently began marketing its CaraSyst software package. Cayce also chairs ALFA’s
recently formed Emerging Technology in
Assisted Living Task Force. As large hospitals
and physicians’ offices get wired to facilitate
rapid exchange of information, she sees
the PDA as a key risk-monitoring device
to allow assisted living caregivers instant
access to medical records, as well as the
ability to send data directly to medical
experts and to input data into medical
records.At CaraVita, caregivers already
are entering key resident data directly into
hand-helds designed to be ready for these
new capabilities.
“Utilization of PDAs and wireless communication, not only for charting, but also
for diagnostics, will facilitate less costly and
more timely care of our residents,” Cayce
says.“For instance, a nurse or care assistant
utilizing a plug-in diagnostic device for
blood or urine can send information on a
resident to the physician’s office at the first
sign of a resident’s change of condition and,
within a matter of an hour or so, receive
an assessment, prescription, and chart entry
that will immediately address the health
situation.All this means better care and
healthier residents.”
Translated another way, companies
on the front end of the technology curve
ultimately will likely see their census on
the rise, Campbell says.“Clients tell us that
they have a competitive advantage to
attract new residents when family members
see their caregivers equipped with the
latest wireless technologies to better
care for their loved one.” ▼
Reach contributing writer Anya Martin at
[email protected].
HISC00_4205_7x10_AD_4C
3/30/05
11:18 AM
Page 1
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G R O W T H
S T R AT E G I E S
RETHINKING
Real Estate Assets
T
he recent years have been
rife with senior living companies strategically moving
from owning their real estate
assets to instead managing or
leasing them.The trend
seemed to start in 2003, when Sunrise
Senior Living announced the sale of 16
of its properties to CNL Retirement
Properties and another five to Macquarie
Capital Partners.At the same time, Sunrise
secured a long-term, manage-back agreement to manage these 21 properties
During third-quarter 2005—Capital
Senior Living Corp. is expected to complete
an approximate $85 million sale-leaseback
transaction for six of its communities with
Ventas Inc.
Why do companies sell their assets? Are
there advantages to moving away from
owning real estate and deploying the resulting capital elsewhere? What can be learned
from the actions of these operators?
On a very basic level, owning real estate
ties up a company’s capital. By selling the
real estate, this capital can be utilized elsewhere, such as redeployment into higherreturning opportunities needed to grow a
business. Let’s say, for example, that you
own a portfolio of three or four properties
with $10 million of total equity capitalization. By selling these assets, the $10 million
can be used as working capital to manage
or lease 10 or 15 properties.
For a publicly traded company, there is a
strong incentive to manage or lease assets
in lieu of owning them, because the equity
markets tend to evaluate an operating company on earnings per share, not on actual
cash flow generated from held real estate.
By owning assets, the company is forced to
carry the real estate depreciation costs on
its income statement. Even though depreci18 SEPTEMBER 2005
,
Senior housing providers
divest real estate assets,
using the resulting capital
to improve operations in
their communities or
expand elsewhere
By Raymond J. Lewis
ation is a non-cash charge (designed to
show that the asset devalues over time),
the cost lowers a company’s net income.
As such, the company’s stock price will not
benefit from the cash flow generated and,
in fact, will be negatively affected by depreciation costs.
Many companies (especially those that
are publicly traded) have decided to sell
some, or all, of their real estate, primarily for
one of three reasons. As previously noted,
these companies are not getting credit from
Wall Street for owning their real estate.
Secondly, the depreciation costs tend to offset any gains realized from increased cash
flow. Finally, these companies can redeploy
the capital received in an asset sale into
investments or projects that will produce
larger growth and higher yields.
PUTTING PROPERTIES INTO PLAY
In the case of Sunrise, the company has
been using its freed-up capital to open communities in international markets, including
Canada and the United Kingdom. Early this
year, the company introduced its first community to Germany, which is a potentially
higher-growth market. According to
Chairman and CEO Paul Klaassen, the
demographics in the major metropolitan
markets in Germany and other European
countries “suggest a demand for high-quality
senior living care and services.”
But even privately held providers may
find it advantageous to sell their real estate.
Consider, for example, companies with
aging properties, especially facilities that are
20 years and older. Properties such as these
are more than likely to have depreciation
issues, requiring significant capital investments for large deferred maintenance items.
Providers may decide that it is better to sell
the properties than to spend the money
required to upgrade them.
Jim Moore, president of Moore
Diversified Services, who advises many
smaller and single-facility operators on their
exit strategies, is well aware of this problem.
“I recommend that clients look at the age of
their properties—even though they may be
superbly maintained—as yet another variable that they are going to need to put on
the table,” he says.“Eventually, those properties will be discounted, not because of their
financial performance initially, but because
of their perceived age. So that’s certainly
another issue that comes into play.”
FINANCIAL STRUCTURES
FOR SOLD ASSETS
Smart companies develop strong portfolios
by employing a three-pronged financial
strategy. These companies strike a balance
among the number of properties they
own, the number they lease, and the number they manage. By having a third of its
portfolio in each of these areas (a good
rule of thumb), a company can ensure
that it realizes the benefits of each of
the three strategies.
To manage or lease properties, a company typically enters into two common
financial agreements.The first type is a salemanageback. Under this arrangement, companies sell off their assets and manage them
back on behalf of the new owner. The company is paid a fee to run the residence—
generally a percentage of revenues, typically
between 3 and 5 percent. Except for paying
this management fee, the new owner of the
real estate receives all of the cash flow that
the property generates.
The second financial arrangement is a
sale-leaseback. In this scenario, after selling
its real estate to the new owner, a company
enters into a long-term (10 years is standard) contract (with that new owner)
that effectively grants the operating
company the right to be the owner for
the period of that lease. This entitles the
operator to receive all of the excess cash
flow… after making a rental payment to
the new owner.
PROFIT-ENHANCING TREND
There is no question that selling real estate
assets is becoming more popular.All large
companies—particularly the publicly traded
ones—have engaged in either a sale-leaseback or a sale-manageback transaction within the past several years. This trend is likely
to continue as more companies recognize
that they can be as, or more, profitable being
a property manager or tenant versus being
an owner of real estate. A company that
enters into one of these transactions will
free up the equity currently residing in the
real estate, allowing it to pursue a business
model that is much more scalable (that is,
the management or operation of residences).
Additionally, valuations are strong for
many sectors of the senior living industry,
a further reason why companies will continue to monetize their real estate assets.
“One might speculate that there’s eventually
going to be a turnaround in the extremely
low capitalization rates currently present
in the market,” says Moore.“Interest rates,
in fact, have been creeping up, and normally,
capitalization rates tend to follow them.
But that has not happened. Eventually,
increasing interest rates have got to have
an impact on cap rate trends. So all the
indicators are very favorable right now,
if you choose to exit.”
NEXT STEPS AND STRATEGIES
Let’s say that you are considering a move
away from ownership of your real estate to
managing or leasing some of your assets.
What steps should you take?
First, you need to do a careful review of
your portfolio. Try to identify, and then prioritize, those assets that you want to monetize. Ask yourself the following questions:
What is the growth in the cash flow stream
of this asset going forward? Does it still
have a lot of opportunity to extract value
through occupancy gains, rent increases, or
by better managing expenses? Is the facility
aging and requiring large influxes of capital? Is the asset stabilized or not?
If the asset is stabilized, it will be harder
to realize significant gains in cash flow.
Instead, you may want to consider selling
the property and redeploying the money
, SEPTEMBER 2005
19
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in a new asset that has not yet stabilized
or one that has more upside potential.
Are there situations where it may be prudent to hold on to an asset? Absolutely.
Consider, for example, the debt associated
with an asset. Is the financing attractive in
today’s marketplace? If not, then it may be
better not to sell the property. Otherwise,
you’ll get penalized in terms of value
because the debt comes along with the deal.
Another reason that argues for holding
on to assets is that a company can always
monetize or borrow against the value of
owned properties at a future date in order
to add more capital back into the company.
Thus, it stands to reason that a company
that sells its assets loses this financial flexibility upon doing so.
After making the decision on whether or
not to sell your assets, there are two choices. If you already have proven management
experience and are looking to grow, you
can either raise equity from various sources
or you can partner with REITs or other real
estate investors. In the latter case, the partner will buy the real estate, and you can
either manage or lease it. Conversely, if
you don’t have quite as strong operations
experience, it may be more advantageous
to first strengthen your management track
record, as financing sources are generally
hesitant to invest with less mature management teams.
So for those with a proven management
track record—especially those operators
with properties in attractive markets—selling some of your real estate assets provides
a way to bring balance into your real estate
portfolio. Having a portfolio with some
assets that you own, some you lease, and
some you manage will give you the most
flexibility.Your owned assets will always
be available as an equity source, and your
off-balance sheet properties (those you only
lease or manage) will help optimize your
operating leverage. ▼
Raymond J. Lewis is senior vice president and
chief investment officer
for Ventas Healthcare
Properties, a REIT with
offices in Chicago and
Louisville, KY. Reach Lewis at 877-4VENTAS or visit www.ventasreit.com.
In our healthcare branch of lending, we’re the specialists. Healthcare and senior housing properties
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056GM577
G R O W T H
S T R AT E G I E S
ON A ROLL?
Market data continues to support strengthening
of assisted living’s market position
By Adam Stone
L
ast quarter’s financial data saw
2005 off to a good start for
assisted living, with strong
occupancy rates and move-in
numbers. Now the second
quarter appears to be continuing the trend, with statistical information
and anecdotal reports all pointing toward
a healthy market demand for assisted living
products and services.
That is certainly the case at Bickford
Senior Living Group, a 31-property enterprise based in Olathe, Kansas.“The second
quarter has been good for us in terms of
occupancy.We also have seen an increase
in terms of move-ins, which again have
outpaced move-outs in the second quarter,”
says Senior Vice President of Operations
Alan Fairbanks (alan.fairbanks@
eby.com). “Our rates continue to be very
strong, especially considering we are not in
the very biggest markets, and we continue
to see those rates rise.”
Fairbanks’ experience confirms the latest
findings from the National Investment
Center for the Seniors Housing & Care
Industries (NIC).Those indicators had a distinctly positive bend in the second quarter.
In terms of occupancy rates,“you see the
continued ‘getting healthy’ of the industry,”
says NIC President Bob Kramer.
Having risen steadily over the past several
years, starting at about the 84 percent
range, occupancy today is holding
stable at 88 percent.
While strong overall, the occupancy
numbers are especially impressive in the
30 largest metropolitan areas, where the
rates continue to run about five points higher than in other markets. In the second quarter, properties in the largest markets showed
an average occupancy rate of 93.8 percent.
“This continues to demonstrate why so
many major operators do concentrate in
the large metropolitan areas,” Kramer says.
In another key indicator of financial
health, major national lenders reported that
nearly all borrowers in the assisted living
category are performing flawlessly. Ninetyeight percent of loans in this arena are
healthy and sound.
In cases where the numbers do look
questionable, researchers say the cause is
most likely a statistical variation. Consider
the CCRC market where occupancy in
these properties dipped to 91 percent in
the second quarter, down from 92.5 in the
previous quarter.“But we have seen this
fluctuate between .01 and .03 percent in
the last couple of years, so this is likely just
a temporary fluctuation,” says NIC Research
Director Tony Mullen.
NIC also began to compile some new figures this quarter, which could help property owners determine the future of their
service mix.While conventional wisdom
tells us that people will pay more money
for more services, the latest numbers offer
some surprises in terms of just how much
more residents and their families will pay.
The typical resident in assisted living
today will spend $2,700 a month for care.
Add dementia care and that number goes
up by $1,500 a month, while private-pay
skilled nursing draws an average $5,200 per
month, almost twice the revenue generated
by assisted living alone.
Numbers like these may be helping to
drive public policy in a way that favors
operators.“There clearly is a progression of
hands-on care and clinical care that is being
provided as you move from assisted living to
skilled nursing, and the government has
finally acknowledged that the margin on private pay is indeed being used to subsidize
Medicaid beds,” Mullen says.“That in turn is
helping keep the reimbursement levels
steadier than they have been in the past.”
The down side is that the steep rise in
cost as care increases can be a detriment to
business overall.“It tends to cause sticker
shock in many people’s minds, so we do
, SEPTEMBER 2005
23
G R O W T H
need to be very sensitive to the value equation,” Kramer says. Operators need to be
ready to demonstrate the value inherent in
those higher-priced levels of care.
PREMIUM PRICES FOR THE
ASSISTED-INDEPENDENT COMBO
In a related development, new numbers
show that the type of property can also
S T R AT E G I E S
have a direct bearing on revenues. Say, for
example, an assisted living residence stands
on a campus that also includes an independent living component. The typical
assisted living resident will pay $550 a
month more in order to be on that combined property, as compared to being on an
assisted living-only campus, NIC found.
It works the other way, too. The average
independent living resident will pay $400 a
month more to live on a campus that also
offers assisted living.
Some see the phenomenon largely as a
product of inertia, as it were, especially
among older people who may be wary of
relocating. For these residents, the promise
of a combined campus offers a readily perceived advantage,“and people have shown
that they are willing to pay the price if they
see added value in your services,” Fairbanks
says.
New NIC numbers also show for the first
time the potential economic advantage in
incorporating some proportion of semiprivate rooms into a residence. The average
semiprivate assisted living unit will generate
revenues of $1,473 per month, while a
semiprivate room in the dementia unit generates $2,077 per month. Both these numbers are 52 percent higher than the per-unit
revenue from comparable private units.
Today, about 12.5 percent of assisted living units are semiprivate, and the NIC figures suggest that number could probably
stand to go a little higher. Still, Kramer says,
it has to be done with a delicate hand, since
demand for semiprivate units will by nature
be limited.
Another surprise in the findings this
quarter was in bigger vs. smaller market
revenue rates, with the gap between the
two running far wider than might have
been expected. In New York City, for example, one day in a private-pay nursing bed
costs $270 as compared to $100 a day in
Dallas. This significant gap may help shape
the market-analysis efforts among firms
with an eye on future geographic expansions. Bigger-is-better is looking better all
the time.
Taking a step back, Fairbanks says the
strong second-quarter numbers are indicative of an industry whose star is clearly on
the rise.“The awareness of our industry
continues to be enhanced,” he says.“We
are getting better at our marketing efforts.
We are getting better at being able to
explain the benefits of assisted living, and
I think the industry as a whole is reaping
the benefits of that enhanced awareness
in the consumer world.” ▼
Reach contributing writer Adam Stone at
[email protected].
24 SEPTEMBER 2005
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Building
EXCITEMENT
Latest trends in new assisted living construction
feature larger living spaces, lots of natural light,
green space, and luxurious amenities
BY ANYA MARTIN
S
unrise at Lincoln Park sports
that signature turret in its corner, and its interior finishes
and upscale elegance mirror
the traditional suburban Sunrise
mansion, but its outer walls
aren’t pastel-painted wood; they’re solid
red brick.The five-story, 68,405-square-foot
building with 45 assisted living and 15
memory-care units blends seamlessly into
the downtown Chicago neighborhood.
“Since the Chicago fire, people don’t
build frame downtown,” says Cindy
Musikantow (contact: 703/273-7500),
senior vice president of market strategy and
product development for McLean,Virginiabased Sunrise Senior Living Inc. “It’s an
all-brick building with retail attached on the
first floor. We’d never done that before.
Now it’s something we consider when we
go into a new area.”
Sunrise’s goal was to provide a product
to attract a new market share of culturally
savvy city-dwelling seniors. Making the
$15.4 million building match the style of
the community helped the company win
the support of locals. Sunrise signed onto a
mixed-use development of condominiums
and shops planned to revitalize a deteriorated area previously home to a bus maintenance and storage facility.The assisted living
community, which opened in February
2004, is linked with it via a 30-square-foot
courtyard. Other unique features include
rooftop decks to compensate for the lack of
26 SEPTEMBER 2005
,
ground-level green space; a city club-like
atmosphere inside, including a posh fifth
floor lounge; and a porch with rocking
chairs where residents can watch the street
action.
Few assisted living providers have been
building from the ground up over the past
couple of years, but those that have are
looking to exciting, new models that blend
seamlessly into their landscapes, both urban
and elsewhere. Units are larger, natural light
streams in, and green space remains the
holy grail.
MORE NEW MODELS
As the nation’s largest assisted living
provider expands its offerings both here in
the United States and in Canada and
Europe, it has been adapting its design to
respond to each unique market and setting,
says Phil Downey (contact: 703/2737500), Sunrise’s senior vice president of
strategy and development.“We find a great
site and then figure out a building that
works on that site,” Downey adds.
Set to open in 2008, Sunrise at Turtle
Creek, just north of downtown Dallas, will
introduce another new Sunrise model for
seniors who want a more urban lifestyle—
an opportunity for equity ownership.
Residents can buy one of 144 state-of-theart premium independent living condos in
the 22-story high-rise, but two floors are
reserved for approximately 40 assisted living and dementia care units. Downey says
the community will distinguish itself from
the average CCRC by making assisted units
virtually indistinguishable in quality and
size from those on the independent floors.
Independent residents with health changes
can choose to move to the assisted levels or
to contract with the Sunrise-At-Home program.And assisted living residents will not
only have their own common areas but
have complete access to the same amenities
as their independent neighbors, including a
full-service spa with treatment and massage
rooms, a fitness center, and multiple dining
environments, which will embody what
Downey calls the “fun and excitement of a
great restaurant experience”—casual areas,
a cocktail lounge, an elevated fine dining
room with views of Lee Park, and a chef
demonstration kitchen.“Everything about
the place is going to be new and different
in many respects,” says Downey.
A community center on the fourth floor
will flow directly into an outdoor terrace,
which Downey says is “going to be a fabu-
Boulder Associates Inc.
lous urban garden.” Other unique design
elements include natural wood accents and
millwork on the interior and generous use
of glass in both units and common areas to
emphasize natural light.
Sunrise plans to open a similar ownership community, Sunrise at Fox Hill, in
Bethesda, Maryland, in 2008, but on a wooded 16-acre site within a dense suburb of
Washington, D.C. That building will be six
stories or less and incorporate a more naturalistic design evocative of the arts-andcrafts design movement from the turn of
the century. It also aims to “set a new standard in this local market and perhaps
nationally in design excellence,” Downey
says. And it will even include a full performing arts center for theater, music, and lectures.
Sunrise’s philosophy of matching exteriors to the surrounding neighborhoods also
has helped it adapt to the European market,
Musikantow says. As in the U.S. urban residences, interiors remain faithful to the
When Eskaton Senior Residences and Services
Inc. acquired 52 acres to build Eskaton Village
Roseville in California, it faced an added challenge.
Seller Stephen DesJardins retained architectural
control of all structures being built on his land,
which already included a business center, upscale
winery, restaurants, and retail and had mandated
that everything down to the window shapes, building
materials, colors, and landscaping resemble a small
town in the Provence region of southern France.
Sunrise model of an adaptive environment
that doesn’t look adaptive, but all five
London and two Hamburg, Germany, communities have different outer looks.“We
integrate features that we know really work
for seniors all around the world, but the
building fits the local market,” she adds.
URBAN OASIS
With America’s increasingly diverse cultural
mix, many people have suggested that the
future of assisted living depends on appealing to people from many different ethnic
backgrounds. At The Plaza at Punchbowl in
downtown Honolulu, Bainbridge Island,
Washington-based Sound Health
Management Inc. has put that theory to
the test by designing a building to appeal
both to Hawaiians and the numerous ethnic
groups that have settled there, including
Japanese, Chinese, Korean, Portuguese, and
Latino. Indeed, assisted living communities
remain a rarity in Hawaii because of its
large Asian population, whose cultural
values encourage family members to take
care of aging relatives.
Another challenge was to balance Sound
Health’s service delivery philosophy with
the realities of the high cost of construction
and land on the islands, says Stephen C.
Wattenbarger (stevew@wattenbarger.
com), owner and president of Bellevue,
Washington-based Wattenbarger
Architects, the project’s design firm. The
six-story building had to fit a tight urban
footprint, requiring that spaces be smaller
than in similar mainland properties.
However, while the building also has independent living units, the rarity of assisted
living in the area helped it score a HUD
grant. Total cost was $22.5 million, $14
million for the building and the rest for
the land.
The Plaza’s exterior is simple and consistent with surrounding midrise structures,
reflecting modest touches of local symbolism in its decorative accents. Inside are 137
studios, and one-bedroom and two-bedroom
apartments, with higher acuity residents
needing 24-hour access to nurses placed on
the third floor, and the second floor devoted to memory-care with its own dining
room and a secure garden terrace with
walking path. Units run from 350 to
850 square feet, designed for maximum
efficiency in limited space by eliminating
hallways and angling bathroom entries and
closet space. Placing the parking lot underneath the building is another space-saving
strategy.
The building’s interior paint and finish
colors show a Japanese influence, while
wood frames and elements match island
architectural aesthetics, says Rick
Tolleshaug ([email protected]),
a principal at Wattenbarger and project
manager.“We picked a darker stain and
oriented the trim to create a fluted or
grooved effect, arranged in that angled
way that makes a very Hawaiian look. It
, SEPTEMBER 2005
27
has a sense of palm trees in an abstract way.”
Sound Health also added more plants
than in its mainland communities and lots
of fresh tropical flowers. Large glass windows don’t just let sunlight stream in but
provide views of a modest but lush social
garden in front and a tranquil healing garden for relaxation and meditation.“Whether
you’re talking about the Asian, Hawaiian,
or even the large Portuguese population in
Hawaii, they all live outdoors and want to
be able to enjoy it,”Wattenbarger adds.
Indeed, the entire lobby, reception, and
activity areas on the first floor were
designed with openness and light in mind,
as well as a synergy among spaces, says Lisa
Skelton (lskelton@soundhealthmanage
ment.com), Sound Health’s operations
officer. “Creating an open feel reflects the
Hawaiian spirit of ohana [family],” she adds.
“There are no closed areas in the reception
area, nobody looking at a closed desk
through a window.”
“All of the spaces are interconnected
visually rather than being separate,”
Wattenbarger says.“Residents walk through
the core of common areas and see a variety
of activities in a number of different places.
They also have the opportunity to preview
what’s happening in the various spaces so
they can make the decision to walk by or
join in.”
That the building is perched on the
slope of Punchbowl Crater, which holds the
National Memorial Cemetery of the Pacific,
had its ups and downs. Being built into a
crater’s edge meant that light only flowed
in from one side, a challenge the architects
met by adding interior windows so sunlight
could pass through every room on the
entire ground level except a private spa-like
private tub area and massage therapy room,
designed with Japanese bathing customs in
mind. On the other hand, the views from
higher floors are stunning, including the
Pacific Ocean and Diamond Head on one
side and the mountains behind.“The design
reflects a desire to create as many ocean
views as we could,”Tolleshaug says.
Sound Health even arranged for a
Hawaiian priestess to bless the construction
site before building commenced and for a
Hawaiian priest to bless each room, even
every closet, upon completion.
28 SEPTEMBER 2005
,
COUNTRY LIVING, LARGER SPACES
Located in a 17-acre wooded site in suburban Springfield, Massachusetts, Keystone
Woods features two separate residences,
The Gardens Independent Living
Community and Grayson House Assisted
Living Community, which includes a
memory-care wing. But anticipation is so
high that while construction would not be
complete for another four months, a
preview party in June attracted 750 people
to tours of model apartments and the unfinished common areas, says Joseph L. Roche,
president of Wilbraham, Massachusettsbased The Roche Associates Inc., the property’s co-developer in partnership with
Franklin, Indiana-based Keystone Senior
LLC, and Tony Mullen, research director of
the National Investment Center for the
Seniors Housing & Care Industries (NIC).
“They were just astonished by the overall
size and design of the assisted living [projet],” Roche says.“Our assisted living apartments probably are 25 to 50 percent larger
in general than the ones in marketplace.”
For the partners, the goal was to differentiate the community from their competitors, he adds. Grayson House is 80,000
square feet, just 20,000 square feet smaller
than The Gardens. Inside, however, there’s
very little difference. The developers opted
for more home-like, larger assisted living
units because consumer research shows
that both seniors and their adult children
saw smaller living quarters as a downside to
assisted living. Conversely, providers were
finding it tougher to rent studios.While the
memory care area includes 346-square-foot
studios, most of the community ranges from
608- to 708-square-foot one-bedroom residences to spacious 784-square-foot deluxe
two-bedroom, two-bathroom units perfect
for couples or for residents who wish to
share. As one tour participant remarked, the
bathrooms themselves were “large enough
to fit 12.” Many apartments also have patios
or balconies.The overall look blends solid
brick and wood siding to mimic a grand
Cape Cod hotel, complete with a whitecolumned porte cochere in front and a
cupola and dormers built into the gray
shingle roof.
Again, natural light is important, in this
case flowing in through bay windows in
both the apartments and in common areas,
Roche says.Thanks to overwhelming positive response from residents in Keystone
Cedars in Cedar Rapids, Iowa, developers
also are incorporating an in-house theater
with a 52-inch television and a popcorn
machine.
“A lot of times, people used to think
about a nice end-of-life living experience;
we’re now focusing on life enhancement,”
Roche says.
In the middle of the property, the developers were banned from building on seven
acres of wetlands, so instead they will transform the sprawling outdoor area into an
asset. The front entrance features a cascading waterfall and a natural walking path
with benches and birdfeeders that allow
residents to explore the woodlands.
Residents also can enjoy flower gardens
and a sculptured garden area with sitting
areas and reflecting pools.
“Some people could say, too bad that
there’s all that wasted land, but I look at it
as an advantage; we can’t take those trees
down,” Roche says.
The community also is built to be energyefficient with tight building seals and other
EnergyStar components, which results in
lower rental fees.The day of the tour was a
hot one, Roche recalls, and even without
power, temperatures were 15 to 20 degrees
cooler inside than out.
TOUCHES OF TUSCANY AND PROVENCE
Two other new assisted living properties
within CCRCs also embody a luxury virtually
indistinguishable from their independent
living neighbors.
Carmichael, California-based Eskaton
Senior Residences and Services Inc. has
been perfecting its vision of blending independent living patio homes and apartments,
a skilled nursing facility, and a central lodge,
including dining areas, wellness center,
other social areas, and assisted living apartments. But when the company acquired 52
acres to build Eskaton Village Roseville in
California, it faced an added challenge.
Seller Stephen DesJardins retained architectural control of all structures being built on
his land, which already included a business
center, upscale winery, restaurants, and
retail and had mandated that everything
down to the window shapes, building materials, colors, and landscaping resemble a
small town in the Provence region of southern France.To ensure complete accuracy,
Eskaton sent the plans designed by Boulder,
Colorado, architectural firm, Boulder
Associates Inc., to a French architect for
review, says Trevor Hammond
(trevorh@eskaton. org), Eskaton’s vice
president of operations.
Construction starts in November, and
when completed in early 2007, Eskaton
Village Roseville’s lodge will boast cement
plaster walls in a variety of warm tones such
as taupes, tans, and some ochre, as well as
stone trim, says Tim Boers (tboers@boulder
associates.com), the principal at Boulder
Associates supervising the design. The casement windows will have a traditional French
appearance with some sporting shutters.
The roof will be clay tile punctuated by
dormers with shutters and chimneys for at
least five fireplaces within. Residents and
visitors will enter through a stone and timber porte cochere into a two-story shared
lobby with a tower in its center that lets filtered daylight flow down from shuttered
windows at the third level.
To one side will be the grand entry into
the two-story assisted living wing, which
includes a living room with French doors,
balcony railings, and library shelving flanking a stone fireplace. Boer adds that “finishes
on walls, drapery, fabrics, and furnishings
will also have the suggestion of being in
France. It’ll be very warm, very inviting.”A
large dining room will feature a serving
kitchen that includes display cooking and
opens up onto a courtyard patio. Upstairs,
residents will have their own bathing area
designed to be spa-like with decorative tiles
on walls, framed mirrors, and subdued lighting.Assisted living residents also can share
amenities available to the independent residents, such as a beauty salon, wellness center, onsite medical office, and conference
center.
The 40 assisted living apartments will
include no studios, just one-bedroom and
spacious two-bedroom apartments.“They’ll
be very similar to the independent living in
terms of finishes and layout,” Boers says.
“They’ll have walk-in closets, generous
windows. For some of the upper-level
units, there are French doors that open
onto a European balcony. The windows are
detailed and the divisions of glass propor-
Even though construction
would not be complete
for four months, Grayson
House Assisted Living
Community hosted a
preview party for 750
people to tour model
apartments and the
unfinished common areas.
tioned to what one would find in the south
of France.”
Large bathrooms will feature roll-in showers, linen closets, and decorative lighting
with a “bit of a French flavor,” Boer adds.
The quality of finishes and other design
elements won’t be compromised in a separate one-story area that will house 24
dementia-care residents, he continues.“The
goal for all levels of care is that residents
feel like they’re in the same lodge, even if
they do move from level to level.” Their
amenities include two dining rooms, one of
which opens into an outdoor courtyard
with vine-covered trellises and elaborate
landscaping.
Another community setting new standards for high-end assisted living is part of
Independence Village at the Dominion, a
CCRC being built by San Antonio,Texasbased Dial Communities Inc. in the
Dominion suburb and designed by Costa
Mesa, California-based Irwin-Pancake
Architects. Planned to blend into the area
where home values range from $2 to $12
million, the long, narrow building will feature lots of towers and domes, says
Gregory Irwin (irwing@irwin-pancake.
com), a principal with Irwin-Pancake
Architects.
The 90 assisted living units are divided
into two levels of acuity, but everything
about the planned design and amenities is
upscale to attract seniors who want to
remain close to family who live in the area.
“It has to be more than a concept if you’re
going to provide assisted living to people at
this level,” Irwin says.“They’re not going to
move out of independent living to a small
place with no services. They can afford to
pay someone to bring services to their
house.”
The country club feel starts in the twostory lobby with an impressive view onto
a golf course.Amenities include a day spa
with beauty shop and massage therapy, as
well as a theater room. Every effort is being
made to make public spaces invite residents
to pause, for example, to view fish ponds
and two-story bird cages.
The one-bedroom apartments cover
more than 720 square feet and include a
butler’s room where staff can pick up or
drop off laundry, the morning paper, or
room service without disturbing the occupant and which can be locked from the
inner residence for privacy. Each unit also
has a washer and dryer connection with a
built-in ironing board. Both living room
and dining room have full window views
with balconies. Bathroom elements to
ensure units look more like a home
include a wall on the side of the toilet,
dual sinks, a make-up area with a chair and
a walk-in closet that opens directly into
the bathroom.
And tech-savvy seniors even have a small
office space to set up their computers.
“What do people do with their computers
in assisted living?” poses Pancake.“They
don’t want it in the kitchen or the bedroom. If they don’t have a computer, it
could also be a sewing room or even a storage area.” ▼
Reach contributing writer Anya Martin at
[email protected].
, SEPTEMBER 2005
29
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S P E C I A L
R E P O R T
Resident-Focused
TECHNOLOGIES
High-tech quality of life enhancements offer a competitive edge
By Jim Moore
ome say high-tech innovation won’t work with
today’s traditional seniors—
a shortsighted view considering the mounting evidence that consumers are
ready to accept and respond favorably
to new beneficial impacts of high
technology. The changing psychographics of today’s senior consumers
make them more computer-friendly.
A growing number of today’s seniors
are technologically savvy as evidenced
by the growth in computer workstations within senior communities—
from one or two seldom-used workstations to 10-15 stations in continuous
active use. Residents increasingly are
including computer workstations within their individual apartments as well.
Couple this with today’s typical 45to 64-year-old sophisticated, computeroriented decision influencer and you
can readily see the growing involvement of high technology in general
and computers in particular. The foundation for applying technology to
enhance seniors’ quality of life in assisted
living communities involves three technological breakthroughs.
1. WIRELESS TECHNOLOGY. Wireless technology expands the potential resident monitoring and other information transfer applications within existing senior housing communities. Hard-wired connections are no
longer required. Infrared and radio frequency (RF) information transfer can distribute
valuable information within a resident’s
living unit and throughout the community
S
to central information gathering points.This
wireless technology also allows practical
expansion and retrofits of existing and
older communities. For example, state-ofthe-art personal emergency response systems can now be retrofitted within existing
communities with relative ease using wireless technology. (The October issue of
Assisted Living Executive will look at life
safety technology solutions.)
2. THE INTERNET. The Net has quickly
transformed a relatively expensive hard-
wired national and international communications network into a flexible,
personalized, and surprisingly inexpensive audio and video gateway to
the world. For example, most of us
already are accessing cell phone, satellite TV, and wireless Internet access.
Today, we can connect residents with
their families or their medical practitioner in a direct personal manner at
virtually no cost. Audio and video conferencing among multiple family
members is now possible, either free
or for a very modest cost. Combine
these capabilities with real-time photo
transfer, e-mail, and instant messaging
and the connection between residents
and their families can be virtually
seamless regardless of geographical
displacement. Equally important is the
vast amount of online information
about the aging process that is now
available from numerous Web sites.
These communications work best
with broadband Internet connections
and can be accomplished either live
(in real time) or stored for on-demand
access by family members on a personal
Web page with information links that can be
accessed anytime.
3. WEB-BASED SERVER TECHNOLOGY.
This technology allows top management to
access and monitor the frontline performance of either an individual campus or multiple communities within a portfolio from
anywhere in the world 24/7 (see cover
story). Essentially, management can easily
telecommute from their “virtual office,”
checking on details of in-house marketing,
, SEPTEMBER 2005
31
S P E C I A L
financial and management information
systems, and even the clinical/directcare status of individual assisted living
residents, by discrete activities of daily
living. Of equal importance, they can
ensure that their operation is maintaining appropriate standards of care and
receiving fair and adequate compensation for services delivered on a resident-by-resident basis.
Are you missing a major opportunity to offer high-tech solutions to
enhance residents’ quality of life? Here
are some ideas.
Voice recognition software that
automatically converts the spoken
voice into typed text, e-mails, or specific
commands in digital format has now arrived
for practical use.With a modest degree of
indoctrination, seniors can avoid the sometimes threatening or difficult task of keystroking or handwriting to communicate
with far away loved ones.Voice recognition
can also transmit digitized requests for help
or other assistance with living needs, which
32 SEPTEMBER 2005
,
R E P O R T
are then transmitted through wireless technology to appropriate monitoring and communication centers.
Menu-prompted computer touch screen
technology provides yet another userfriendly computer communication interface
for seniors.A simple example would be a
friends-and-family address book whereby
seniors using touch screen technology can
make automatic e-mail and telephone
connections. A daily “I’m OK” or
other frequently used messages or
requests to family members can also
be incorporated within a customized
touch screen format. Conversely, text
can now be converted to a spoken
voice for information transfer to visually impaired seniors.
New emerging technology also is
addressing two significant health-care
issues involving seniors. Medical practitioners don’t make many house calls
anymore, and not all general practitioners have a depth of experience in
geriatrics. Extensive communication
and doctor-patient interaction are being
accomplished via the Internet along with
the transfer of vital signs and other medical
records. In addition, family and medical
practitioners are accessing the best available Internet information on geriatrics that
is now available from both United States
and international sources.
While not totally replacing doctors’
S P E C I A L
R E P O R T
THREE PRINCIPLES OF RESIDENT TECHNOLOGY
f some of this appears blue sky to
you, it’s time to start an information
technology initiative for your community. The senior housing business overall
is clearly behind the power curve in the
practical exploitation of today’s available technology. We can easily bridge
the gap between available high technology and serving residents in an innovative, but practical, manner. But don’t
get too carried away with high technology. In dealing with residents (and
their families), high technology must
focus on three basic principles:
■ Sustaining or enhancing standards of care and quality of life for
your residents and their families.
■ Creating a seamless four-way
communication between the senior,
your professional staff, the family, and
possibly a family medical practitioner.
■ Achieving a delicate balance
between high-tech and high-touch, while striving to improve the economics and effectiveness of serving seniors. This means we must enhance staff productivity with new technology with absolutely no compromises in a senior’s quality of life.
I
bedside manner of the past, new technology has dramatically closed the information
and communications gap between the senior, family members, and the medical practitioner. Technology also has intensified
and enhanced the flow of important geriatric information. A geriatric health-care
clearinghouse of valuable information
could exist within the next several years.
The nuclear family may be largely a thing
of the past, but the concept of the “virtual
family” is fast becoming a reality through
advances in technology. Consider these realworld innovations:
■ Grandma can play simple games with
the grandkids via an Internet connection.
■ Using low-cost Webcams, geographically
displaced family members can view live
video images of each other as they privately
communicate by both voice and live text—
at no additional cost. In addition, a “white
board” capability allows grandchildren to
draw pictures with Grandma watching (live).
■ Photographs with family member
voice-over can be transmitted either live or
34 SEPTEMBER 2005
,
While not totally replacing
doctors’ bedside manner of
the past, new technology
has dramatically closed
the information and
communications gap between
the senior, family members,
and the medical practitioner.
stored on a family Web site for viewing and
listening on demand by the senior.
■ For some time, many senior living communities have had special TV channels for
their residents. Now these channels are
being highly customized by specific campus living arrangement (independent living,
assisted living, etc.) and resident interests
and preferences. Far away family members
can also tap the goings-on at their loved
one’s community by accessing this information via a customized Web site—one that
frequently changes content daily.
Long-distance phone charges are plummeting as carriers merge and scramble to
capture market share. But while this is
occurring, the Internet offers increasing
communications capabilities—at little or
no cost. Much of this capability works best
with broadband (cable, satellite, or DSL)
computer hook-ups. Once thought to be a
serious limitation with consumers, we now
know that broadband Internet connections
have established a surprisingly high consumer market penetration.
Satellite radio broadcasts hundreds of
stations representing vast geographical and
program content diversity. Today’s seniors
grew up during the radio era and many may
find this to still be an interesting experience.
Digital video recorders (like TiVo) can
store TV programs as well as transmit
them to other TiVo-equipped locations.This
means that seniors and their families can
enjoy programs and favorite movies long
after the actual broadcast.
These are just a few examples.The future
potential is high. Introducing high technology has significant upside potential and
embracing it does not have to be a high-risk
endeavor. In fact, senior living can succeed
in the high-tech world where many companies failed when the Internet bubble burst.
In most cases, the technology was sound,
but many companies lacked a marketresponsive product or a flawed business
mode.That is certainly not the case with
assisted living.
We must use existing and emerging technology to enhance the standards of care
and quality of life of residents, while also
improving the operational effectiveness
of assisted living communities. ▼
Jim Moore is president
of Moore Diversified
Services Inc., a national
senior housing and
health-care consulting
firm based in Fort Worth,
Texas. He is the author of
Assisted Living Strategies for Changing
Markets and Independent Living
Congregate Care and CCRCs. Reach him at
817/731-4266 or [email protected].
A R B I T R AT I O N A G R E E M E N T S I N A S S I S T E D L I V I N G
With Arbitration, Resident
Disputes Are Resolved
Faster, Cheaper
BY LORETTA LEBAR AND
KEITH MAURER
roviders of healthcare services nationwide are choosing
arbitration to resolve
disputes with consumers,
and for good reasons: It
costs less, it saves time,
and it’s fair.
Courts and commentators find arbitration is less
expensive compared with
overall litigation costs. Part
of the cost savings results
because arbitration is
much faster than litigation.
The U.S. General
Accounting Office (GAO)
found that arbitration hearings typically
require two to four days, compared with
several weeks for court hearings in traditional litigation. Researchers conclude that
individuals fare at least as well in arbitration
as they do in court. Plus, a Kaiser
Permanente study found that arbitration
participants report a high degree of confidence in arbitration.
Including arbitration clauses in providerconsumer agreements at the start of the
business relationship keeps both parties
out of expensive, often sluggish lawsuits
in favor of what arbitration proponents
describe as a fair, inexpensive, and efficient
system.
P
LEGAL PRECEDENTS
Agreements to arbitrate, including those
contained in assisted living resident docu-
ments, generally are governed by the
Federal Arbitration Act (FAA).The FAA represents Congress’s strong endorsement of
arbitration, and requires that arbitration
agreements be enforced as written, subject
to the laws that govern all contracts. Some
states have enacted laws to govern arbitration in the health-care field, but the FAA
pre-empts state laws that are inconsistent
with its guidelines.
Courts have repeatedly reaffirmed the
role of arbitration in all areas of business
and consumer transactions, including health
care and long-term care. In Madden v.
Kaiser Foundation Hospitals, for example,
the court compelled arbitration of a medical malpractice claim brought by a state
employee against a health plan, honoring
the agreement to arbitrate between the
state of California and the health plan.The
COMPLIANCE CORNER
court concluded that arbitration was “an
accepted and favored method of resolving
issues … praised by the courts as an expeditious and economical method of relieving
overburdened civil calendars.”
In a recent Florida case, Blankfeld v.
Richmond Health Care, the court did not
enforce an arbitration agreement because
it substantially limited
the remedies created by
Florida’s Nursing Home
Residents Act.The court
also ruled that a substitute decision-maker or
statutory health-care
proxy did not have
the authority to bind a
nursing home resident
to arbitrate claims in
that state.
These decisions, as
well as others, provide
guidance to assisted
living providers when
using arbitration in their
agreements with consumers.The Florida
Court’s finding illustrates
the importance of using
only fair arbitration procedures and not over-reaching. Managing litigation risks through the use of arbitration
makes sense so long as the procedures and
methods used are fundamentally fair, welltested, and have a history of being accepted
by the courts.
WHAT, WHEN, AND HOW
Critics of arbitration contend that parties
should be offered the choice between arbitration and a lawsuit only after a dispute
arises.They disagree that arbitration has all
the attributes espoused by its proponents,
and argue that if it does, parties will gladly
agree to arbitration post-dispute, rather than
in a pre-dispute arbitration agreement.
Researchers, however, have found that
post-dispute arbitration agreements often
fail to provide reasonable hope of resolving
a legal dispute outside litigation.The odds
, SEPTEMBER 2005
35
COMPLIANCE CORNER
are not great that an agreement for binding
arbitration would be entered after a dispute
has arisen. At that stage, parties already are
polarized about the dispute itself, and one
party or the other will have a view that traditional litigation offers some advantage,
which they likely will not voluntarily relinquish by choosing to arbitrate. Berkeley
University researchers have found that both
businesses and individuals are hurt by the
failure to establish an agreement in advance.
An arbitration clause needs to be consumer friendly, which is possible without
sacrificing the care provider’s objective to
have disputes resolved efficiently, rationally,
and inexpensively by arbitration. Select a
reputable independent entity to administer
the process.The National Arbitration Forum
(NAF) is a good source, for example, offering a reputable panel of arbitrators, reasonable fees, and efficient rules of procedure.
Keep these points in mind throughout the
process:
■ Make the agreement mutual and allencompassing. The agreement should bind
both the consumer and the provider and
state that all disputes will by decided by the
arbitrator. In other words, both billing disputes brought by the provider and negligence claims brought by the resident
should be covered.
■ Prevent financial burden. The cost
of arbitration should not stand in the way
of people bringing a claim. By referencing a
reputable administrator’s rules in the agreement, drafters may automatically incorporate the fee schedules that typically reflect
reasonable fee allocation among the parties.
■ Tell the truth and be open.The
agreement should make it clear to the consumer that he or she is foreclosing the
option of a judge or jury trial and instead
agreeing to an alternative forum.
■ Make it optional. Consider allowing
consumers to enter a residency contract
even if they choose not to sign the agreement.Alternatively, allow consumers to opt
out of the arbitration provisions within a
certain period from signing, such as 10 days.
■ Invoke the FAA. State arbitration laws
vary from one state to another. By invoking
the FAA, health-care providers can use the
same agreement in several states and parties are assured that the agreement will be
enforced according to its terms.
36 SEPTEMBER 2005
,
ARBITRATION AT-A-GLANCE
quick look at some arbitration
basics for assisted living providers:
(Go to www.arbitration-forum.com for
more information.)
■ Arbitration allows assisted living
providers and consumers to resolve
disputes without resorting to lawsuits.
In arbitration, the disputing parties
present their side of the story to an
arbitrator or panel of arbitrators. An
arbitrator is a neutral person who hears
all sides of the dispute, decides the
matter, and issues an award. This award
is binding and legally enforceable, and
can be reviewed by the courts.
■ Consumers typically agree to arbitration through admission documents
upon becoming a resident at a provider
community. An arbitration agreement
is a legal contract between two parties.
■ Arbitration is similar to court in
some ways but is far less expensive
and less time-consuming than filing a
lawsuit. Legal experts have concluded
that consumers win at least as often
and receive as much compensation in
arbitration as they do in court.
A
The following is a sample clause and has
withstood many legal challenges. Note that
it is not intended as legal advice nor intended as a substitute for obtaining legal advice
from competent, independent, legal counsel.
“By signing this agreement, the resident
agrees with the facility that any dispute
between you and us, including any services rendered prior to the date this agreement was signed and any dispute arising
out of the diagnosis, treatment, or care of
the resident, including the scope of this
arbitration clause and the arbitrability of
any claim or dispute, against whomever
made (including, to the full extent permitted by applicable law, third parties who
are not signatories to this Agreement)
shall be resolved by binding arbitration
by the National Arbitration Forum, under
the Code of Procedure then in effect.Any
award of the arbitrator(s) may be entered
as a judgment in any court having jurisdiction. In the event a court having juris-
diction finds any portion of this agreement unenforceable, that portion shall
not be effective and the remainder of
the agreement shall remain effective.
Information may be obtained and claims
may be filed at any office of the National
Arbitration Forum, at www.arbitrationforum.com, or at P.O. Box 50191,
Minneapolis, MN 55405.This agreement
shall be governed by and interpreted
under the Federal Arbitration Act, 9
U.S.C. Sections 1-16.”
This agreement binds all parties whose
claims may arise from or be related to treatment or services provided by the residence,
including any spouse or heirs of the resident. The consumer understands that the
result of this arbitration agreement is that
claims, including malpractice claims he/she
may have against the residence and its
employees and agents, cannot be brought as
a lawsuit in court before a judge or jury, and
agrees that all such claims will be resolved
as described in this section.
The consumer also understands that
nothing in this agreement prevents him or
her from contacting regulatory or administrative agencies in relation to services provided by the facility, and that, once admitted, the resident cannot be discharged for
refusing this agreement.
Putting the management of the arbitration into the hands of skilled arbitrators provides an even playing field that is often not
found in the litigation setting. Using a tested
arbitration clause that does not put limits or
restraints on resident rights or remedies provides the best opportunity to steer future
disputes away from the courts. ▼
Loretta LeBar is of counsel
for the law firm Stoll
Keenon & Park in
Lexington, KY. Reach her
at 859/231-3693 or
[email protected].
Keith Maurer is director of
healthcare and insurance
ADR (alternative dispute
resolution) services and
assistant general counsel
for the NAF in Minneapolis. Reach him at
952/516-6426 or [email protected].
TEXAS ASSISTED LIVING ASSOCIATION
Accreditation Victory Fuels
a Legislative Campaign
BY BECKY SQUIRES AND SKIP COMSIA
n past years, the Texas Assisted Living
Association (TALA) merely reacted to
legislative issues rather than meet them
head on. During each session, the organization would hold its collective breath and
wait for what the legislators decided.Then
the association would rally the troops and
do whatever was necessary to make the legislative decision less burdensome for members.We often got the things we wanted
from our legislators, but we did not actively
seek them. For instance, a few years ago we
were able to get aging in place legislation
passed, but only by tacking it on as a quid
pro quo to other legislative issues. During
the last session in 2003 (the Texas legislature meets every other year),TALA joined
with health-care organizations to get tort
reform legislation passed.
This year, however,TALA took a different
stance—a proactive one—and lobbied to
pass legislation for accreditation in lieu of
annual licensing surveys.With support from
Sen. Kyle Janek and Rep. John Davis, the
Texas Department of Aging and Disability
Services (DADS) is now required to accept
an accreditation report from any approved
accreditation authority, such as the Joint
Commission on Accreditation of Healthcare
Organizations (JCAHO) or the Commission
on the Accreditation of Rehabilitation
Facilities (CARF), in lieu of an initial or
annual licensing survey. Because it eliminates initial and annual inspection requirements, the legislation provides assisted
living communities a real incentive for
pursuing JCAHO or CARF accreditation.
The program is purely voluntary.
Communities may still choose to be surveyed by DADS, and the state will continue
to conduct complaint investigations. In
I
these cases, however, the legislation provides time for DADS to adopt rules and otherwise implement the optional accreditation
program.And, perhaps as important as the
initial legislation,TALA will work with DADS
over the next several months to establish a
successful and fair accreditation program.
ACCREDITATION BONUS BENEFITS
Many providers consider accreditation a
business strategy to support performance
improvement.Texas assisted living
providers report many benefits of integrating the accreditation authority’s standards
into the culture of their organizations to
continuously improve the quality of their
services.
Benefits of investing in
accreditation include:
1. Peer review and consultation
conducted by an independent thirdparty accreditor
2. Self-evaluation that discloses policies
and procedures in need of improvement
3. Increased satisfaction in the organization expressed by the persons served,
leadership, and staff
4. Improved employee team communication and interaction
The Senior Star Living communities
in Texas—12 Oaks East and 12 Oaks
Irving—chose CARF accreditation a few
years ago and feel it was a wise decision.
They have seen an increase in the quality
of resident care as well as a decrease in
employee turnover. Mike Cawood, 12 Oaks
East executive director, says the operational
AFFILIATE SPOTLIGHT
improvements at his community are like
“the difference between a bachelor’s degree
and a master’s degree.” In other words, he
says, the accreditation took resident care to
the next level. Since the CARF (and JCAHO)
standards are outcome-oriented, unlike the
action-oriented state regulations, employees
are empowered to become more engaged
with the residents, predicting needs, and
enhancing care.
Staff at 12 Oaks East and 12 Oaks Irving
also have found that accreditation boosts
their marketing efforts.The average consumer may not be familiar with the specific
accrediting organizations, but they certainly
can recognize exemplary standards which
must be met to receive an accreditation.
The successful accreditation initiative
has fueled TALA’s proactive legislative drive.
The next legislative session begins in
January 2007 and the association already is
planning its agenda and forming strategic
partnerships to strengthen its lobbying
efforts. To date, there are three initiatives
TALA will pursue in the next session—medication packaging, state rule interpretations,
and deficiency reporting.
MEDICATION PACKAGING
Currently,Texas assisted living residents
may obtain their medications from any
pharmacy they choose and the provider
may require that those medications be
packaged a certain way. Many providers
have established packaging requirements
to help eliminate medication errors.TALA
will ask the state to mandate that all medications sent to assisted living properties
be packaged by dose by the pharmacy.
The rationale for this initiative is three-fold:
fewer medication errors, reduced risk, and
less waste resulting in reduced costs.
The immediate and greatest benefit of
this initiative is the reduction of medication
errors since the pharmacy would be solely
responsible for appropriately prepackaging
medications. Fewer medication errors result
in reduced risk on the part of the provider.
Pharmacies would be allowed to accept
returns of unused and unopened medica-
, SEPTEMBER 2005
37
AFFILIATE SPOTLIGHT
tions to reduce waste and ultimately costs.
Additionally, pharmacies would be allowed
to use medications from entities that do
not use dosage packaging (such as county
health clinics or mail order pharmacies)
as stock or to repackage them.
STATE RULE INTERPRETATIONS
Currently, the state regulatory authority
issues rule interpretations without any
input from the provider community. It also
issues life safety interpretations in one
region that don’t apply to another region.
TALA will push for legislation that will
require the state to include provider input
in the rule and life safety interpretation
process, with the recommendation that
these interpretations be applied evenly
throughout the state.As a part of this legislation, the state would be required to issue
AT-A-GLANCE:
Assisted Living in Texas
■ http://tala.home.texas.net
■ Number of licensed assisted living
providers:
1,398
■ Number of assisted living units:
43,875
■ Number of TALA provider members:
235
■ Number of assisted living units
among TALA members:
11,872
■ Average number of assisted living
units per TALA member:
50
interpretations specifically tied to an existing assisted living regulation.
DEFICIENCY REPORTING
4HE$RIVETO3UCCESSIN3ENIORS(OUSING
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Currently, deficiencies reported during
inspections are posted on the DADS Web
site for public review. Consumers can
check a property and see a list of deficiencies before choosing a residence for themselves or a loved one.This is currently a
one-sided list. Deficiencies are listed even
if they are later found to be invalid or if
they are minor and corrected immediately.
TALA will seek legislation to allow for
provider response to the deficiency—
such as the plan of correction filed or
the plan to take the issue through the
informal dispute resolution process—
posted online along with the reported
deficiency. ▼
Becky Squires
([email protected])
is TALA executive director. Skip Comsia
(skip@verandaliving.
net) is chairman of
TALA Board of Directors.
Contact them at
512/479-0425.
Michael Crowe J.D.,
Susanne Matthieson
M.B.A., and Mike
Cawood contributed
to this article.
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report
A research
has been redefined
“The ALFA Executive Portfolio will definitely cause
a ripple at your company. It will challenge
what you thought you knew about the assisted
living business and give you insights in
surprising ways.” Tom Grape, Chairman & CEO
Benchmark Assisted Living
Everyone wants to know what’s on the
horizon for assisted living. But without a
clear map, planning can be a challenge.
ALFA’s 2005 Executive Portfolio: Inside the Minds
of Leading Executives in Assisted Living
& Seniors Housing reveals jaw-dropping
insights from a “who’s who” of assisted
“. . . an indispensable market research
living executives. The ALFA Executive
report detailing unprecedented executive
Portfolio challenges business model
perspectives from leading companies,”
assumptions of the past, fueling
Tiffany Tomasso, COO
renewed dialogue about the future.
It is not just another research report.
“No assisted living executive can be without
Key Findings...
this ground-breaking insider report.
It’s critical to operational excellence and
■ Rapid acceleration in new capacity
keeping ahead of the competition.”
may occur between 2008-2009,
Steven Vick, CEO, Signature Senior Living
“. . . challenges my business assumptions
and shows me what the bigger
competition is planning for. This
report is vital to my business.”
Skip Comsia, CEO/President
Veranda Living Inc.
“In this constantly changing assisted living
industry, the ALFA Executive Portfolio is the
definitive tool for busy executives trying to
keep up with the direction of the industry in
a variety of operational areas.”
Loren Shook, President/CEO & Chairman
Silverado Senior Living Inc.
leading to a short over-supply period.
■ Five key growth drivers include
organic new expansion, predatory
M&A, and others.
■ Pricing is migrating to a tiered model
with concierge-style service options.
■ Independent living, home care,
and CCRC models impact assisted
living’s market definition.
View the first few pages at:
www.alfa.org/public/articles/ALFAExPort_C1-9.pdf.
Purchase the ALFA Executive Portfolio at:
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CONSUMER VOICE
O N
A G I N G
A N D
I N D E P E N D E N C E
Focus on Resident Strengths,
Not Weaknesses, To Boost
Quality of Care
BY KATE NEWTON
onsumers look to assisted living
communities and caregivers to provide a positive environment where
residents can focus on their strengths and
abilities—not their limitations. As a society
“we tend to focus on what they can
no longer do well or do at all,” says Jeff
Ferguson (jferguson@ericksonmail.
com), president of management and operations for Baltimore-based Erickson Retirement Communities. “Our approach is to
find out what capabilities people posses
and work with them as distinct individuals.”
A new program called Champions
of Change at Erickson Retirement
Communities is focused on creating
positive, goals-oriented environments
for Erickson residents and boosting quality
of care efforts companywide.The goal is
to optimize residents’ well-being through
active aging and a commitment to initiatives that focus on people’s personal
strengths and preferences—whether they
live completely independently or in assisted living or skilled nursing communities.
“This person-centered and strengthbased model benefits those who live on an
Erickson campus by teaching our staff to
focus on what a resident can do, not on
what he or she cannot do or has trouble
doing,” Ferguson says.
C
BUILDING COMPANYWIDE CHANGE
Champions of Change is directed by Judah
Ronch Ph.D. (jronch@ericksonmail.
com), vice president of mental health and
wellness for the Erickson HealthSM system. “We use the most available personal,
40 SEPTEMBER 2005
,
The Champions of Change
program at Erickson
Retirement Communities
creates positive, goals-oriented
environments for residents
and boosts quality of care
efforts companywide.
family, and community resources and the
least necessary professional intervention to
achieve the best outcomes in line with each
person’s preferences,” says Ronch, whose
background includes years of clinical and
research-based experience.
The company recently held a three-day
training session to launch Champions of
Change.
“This isn’t something that could go out
in a companywide memo or trickle down
from the top,” Ronch says.“Each individual
campus is driving the process for its
campus, based on the unique needs of
the people who live there.”
Each community has one to five champions who work with Ronch to weave the
person-centered, strengths-based philosophy into various facets of campus life.
Twenty-five employees from 13 Erickson
campuses attended the training session.
They are now the program’s ambassadors
at each location.They also will identify and
work with a team of departmental and resident champions to maximize collaboration.
Resident Life Director Kelly Trudell
([email protected]) says the
staff at Henry Ford Village in Dearborn,
Michigan, guide the program there.
“A lot of people on the staff have been
here a long time,”Trudell explains. “They
have histories and close relationships with
the residents. They’ve known these people
for the last nine or 10 years. Maybe they’ve
been with them through the birth of a
great-grandchild or the loss of the spouse.
In some situations, the staff can act as the
residents’ memory and remember their
strengths even as they themselves start
to forget.”
UNIQUE CHALLENGES, BIG BENEFITS
Providing care from a perspective of
strength and ability is a change that must
also affect the way staff members and
residents think, which can present unique
challenges.
For example, Henry Ford Village has
been open for more than 10 years, so
“routines and the campus culture are
well established,” Trudell says.“What
we’re really trying accomplish is to challenge the staff and residents to rethink
the what, who, where, and why of how
we approach care and respond to residents as individuals.”
Lyn Lubic ([email protected]),
marketing director at Greenspring,
an Erickson community in Springfield,
Virginia, agrees that such substantive
change is difficult—but the benefits
are great.
“This is going to be a welcomed stretch
for staff because it’s essentially changing
the way we do business. Our staff is ready
and eager for the change.We want to do a
better job.
“The residents can give us their perspective and can talk to the resident body
better than we can, getting information out
to their neighbors as their peers,” Lubic
continues.“We also want to use residents’
background and expertise in fields like
health care as we try out new programs.”
The initial Champions of Change action
plan for Greenspring includes holding
PRINCIPALS WANTED
To develop a continuing care
retirement community on property
located in the Appalachian
Mountains. This property is located
near the new I73 & I74 currently
under construction and a proposed
new county airport. Said property
is within the corporate limits of a
small town and adequate utilities
available. The owner can be
reached by addressing inquiries to:
Clarion Bathware
RESOURCE LINK
44 Amsler Ave.
Shippenville, PA 16254
814/226-5374 ext 822
Faxfor814/226-0730
dementia training
all staff, starting
an adult daywww.clarionbathware.com
program, expanding a fall
[email protected]
prevention
program, and taking apartment
customization services a step further to
Celebrating
ourneeds
30th regarding
anniversary
better meet
residents’
Bathware
in 2003,
dementia
issues,Clarion
low vision,
hearingis proud
to be and
a leader
impairment,
gait. and innovator in
living industry.
the assisted
Michael
Shaw (mshaw@ericksonmail.
over 50 models
of of
com) isManufacturing
the associate executive
director
andErickson
ADA compliant
units.
Eagle’saccessible
Trace, a new
community
Clarion
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existing communities,
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change,bathtub,
” he says.“With
start-up
like Eagle’s
Trace or Sedgebrook [in Lincolnshire, Illinois],
we have the chance to weave this philosophy
into our culture from the inception.
“The heart of person-centered care
BUS INC.
involves many areas,” Shaw continues,“but
a
company
three particularly stand out: utilizing lifeInc.individlong learning Champion
as the basis toBus,
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P.O. Boxelder
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ual development; avoiding
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800/776-4943
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ences and capabilities.
Eagle’s Trace is trying
www.championbus.com
to set a tone and
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[email protected]
consumers can
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move in.”
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KEYis a
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Industries,
At all campuses—whether
brand
new,
North America's
leading in
fully developed,
or somewhere
manufacturer ofof
small
to midsize
between—Champions
Change
will
tour,
transit,
shuttle
and
evolve church,
along with
the
campus
and the
para-transit
population.buses. Ranging in sizes
resident
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passengers
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through palliative care,” says
all the way
Ronch.“In some ways, this is what we
already do, but as the company continues
MAY 2004 A S S I S T E D L I V I N G T O D A Y
to grow, this is the right time to really formalize and solidify this culture throughout
the company and help people understand
why it’s so important.” ▼
Kate Newton is the corporate communications
manager for Erickson
Retirement Communities.
Reach her at 410/4022025 or knewton@
ericksonmail.com.
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, SEPTEMBER 2005
41
Pag
PEOPLE & PLACES
SALES & NEW DEVELOPMENTS
than $750,000 on renovations,
including interior upgrades and
exterior landscaping and walking paths.
Summit Builders, based in Phoenix, in July completed construction of a major
expansion and renovation to The Terraces, a CCRC in Phoenix that provides
independent living, assisted living, and skilled nursing residences. The expansion
and renovations include a 124-apartment independent living building, a 74-unit
assisted living center, and a 50-bed skilled nursing facility.
(ARC), based in Brentwood,
Tennessee, has begun construction on a 57-unit expansion to
the health-care center at its
Freedom Village at
Brandywine community near
Philadelphia.The approximately
$11 million project will renovate
units for 63 new assisted living
residents and reconfigure the
health-care center to enhance
dementia care and skilled nursing services.
ARC has completed its
$23.4 million purchase from
Maybrook Realty of a senior
living community in Phoenix,
which ARC had previously
leased.The company also has
purchased the interests of its
joint venture partner in a 47unit assisted living community
called The Villages in The
Villages, Florida. Plus, the company has agreed to purchase
land and placed an option on
an additional land parcel for the
future expansion of The Villages
community.
Silverado Senior Living, based
in San Juan Capistrano,
California, in August opened a
42 SEPTEMBER 2005
,
56-unit memory care community in Plano,Texas. Silverado
acquired ActivCare at
Gleneagles and renamed it
Silverado Senior Living—Plano.
The company will spend more
Sunrise Senior Living REIT,
based in McLean,Virginia,
entered into an agreement to
acquire controlling interests in
13 U.S. assisted living communities valued at $290 million,
reflecting a 7.7 percent capitalization rate on expected net
operating income.Acquired
from an institutional partner of
Sunrise Senior Living, the controlling interest acquired by the
REIT represents an approximate
75 percent ownership of the
communities.The remaining
25 percent will continue to
be owned by Sunrise.
APPOINTMENTS & PROMOTIONS
Wellesley, Massachusetts-based Benchmark
Assisted Living has promoted Jack McCarthy
to chief operating officer (COO). McCarthy
most recently served as Benchmark’s senior
vice president of sales and marketing.
Based in Chicago, Covenant Retirement Communities has
appointed Timothy Johnson chief operating officer (COO).
Johnson most recently served as vice president of
Presbyterian Homes, a not-for-profit seniors housing and care
organization based in Evanston, Illinois. In his new role as
COO, Johnson is responsible for overall operations for not-forprofit Covenant Retirement Communities and its 14 retirement communities nationwide.
Asbury Services, based in Gaithersburg,
Maryland, has appointed Terry Thompkins
Sr. regional vice president of operations—
southwest. In that role,Thompkins is responsible for directing operations of Inverness
Village,Asbury Services’ affiliate in Tulsa,
Oklahoma, as well as managing growth opportunities in the
company’s southwest region.
Sterling Glen, a New York-based
seniors housing provider, in May
opened a new assisted living floor
at Sterling Glen of Stamford, in
Connecticut. The community has
14 assisted living apartments and
152 independent living units.
CORPORATE NEWS
With headquarters in Louisville,
Kentucky, and Chicago, Ventas
Inc. agreed to sell 3.2 million
shares of its common stock to
Merrill Lynch & Co., as solo
underwriter, in an underwritten
public offering.Ventas expects
to receive net proceeds of
about $97 million from the sale.
(ARC), based in Brentwood,
Tennessee, has been added to
the Russell 2000 Index, which
measures the performance of
the 2,000 smallest companies
in the Russell 3000 Index.
New York-based One Lantern
Senior Living agreed to acquire
substantial interests in 17 communities from Needham,
Massachusetts-based Newton
Senior Living, which include
1,655 units and are located in
Massachusetts, Rhode Island,
Connecticut, New York, and
Pennsylvania. Atria Senior
Living Group, based in New
York and an affiliate of One
Lantern owner Lazard Senior
Housing Partners LP, will manage the acquired communities. ▼
AD INDEX
A L FA B O A R D O F D I R E C T O R S
Chair: Steven Vick, CEO
Signature Senior Living
Vice Chair: Michel Augsburger, President & CEO
Chancellor Health Care Inc.
Secretary: Tiffany Tomasso, COO
Treasurer: John “Skip” Comsia, President
Veranda Living
Immediate Past Chair: Thomas Grape, Chairman &
CEO, Benchmark Assisted Living
Evrett W. Benton, President, CEO, and Secretary
Five Star Quality Care
Beth Cayce, CEO
CaraVita Senior Care Management Services
Horace D’Angelo Jr., President
Caretel Inns of America
Joe Eby, President
Bickford Senior Living Group Inc.
Thomas Fairchild Ph.D., Director, Special Projects on
Aging, University of North Texas Health Science Center
Jeff Johns, President
Carriage Court Communities
W. Bradford Klitsch, Vice President of Market
Development, Direct Supply
Mark Ohlendorf, President & CEO
Alterra Healthcare Corporation
AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA) . . . . . . 16
202/783-2242
www.aahsa.org
CARAVITA SENIOR CARE MANAGEMENT INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Beth Cayce, 800/566.3872
www.caravita.com
CNL RETIREMENT CORP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
800/522-3863
www.cnlretirement.com
DIRECT SUPPLY HEALTH CARE EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4
800/216-4832
www.directsupply.com
GMAC COMMERCIAL MORTGAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
888/334-GMAC
www.gmaccm.com
HOMEFREE SYSTEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Brian Verban, 800/606-0661
www.homefreesys.com
HOME INSTEAD SENIOR CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Holly Batchelder, 888/484-5759
www.homeinstead.com
IDEAL SOFTWARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Lance Raab, 813/864-2160
www.idealsoft.com
Ross Roadman, SVP for Investor Relations and
Strategic Planning
American Retirement Corporation
IT POWERED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Loren Shook, President, CEO & Chairman
Silverado Senior Living
INTRACARE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
AAEC Representative:
Sally G. Michael, President
California Assisted Living Association
COS Representative:
Eric L. Johnston, President
Retirement Community Specialists Inc.
Steve Arndt, 866/217-7804
800/395-0132
www.itpowered.net
www.intracare.com
JCH CONSULTING GROUP INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Jim Hazzard, 888/916-1212
www.jchgroupinc.com
K&B UNDERWRITERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
703/761-7088
www.kbunderwriters.com
A L FA P R E S I D E N T ’ S C O U N C I L
MICROFRIDGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Michael H. Cook, Baker & McKenzie
Brad Klitsch, Direct Supply Healthcare Equipment
Susan V. Kayser Esq., Duane Morris
Joel Goldman, Hanson Bridgett Marcus
Vlahos & Rudy
J. Michael Stephen, Health Care REIT Inc.
Joe Whitt, HomeFree Inc.
John Baker, IMA Financial Group
Vivek Bhide, Invista
Bryan A. Baird, K&B Underwriters LLC
Casey Pittock, Lifeline Systems Inc.
Art Seifert, The Lighthouse Companies
Carol A. Muratore, McKesson Medical Surgical
Lisa Hanauer, MED-PASS Inc.
Curt Schaller, Merrill Lynch Capital
Elizabeth Finn-Elder, Nathan Sallop Insurance Agency
Inc.
Debbie Zwiefelhofer, Novartis Nutrition Corp.
George F. Quintairos, Quintairos, Prieto, Wood &
Boyer PA
Stephan Axelrod, SeniorMed
Norrell Walker, Senior Psychological Services Inc.
Kevin Pope, Stanley-Senior Technologies Inc.
Loretta LeBar, Stoll Kennon & Park
Douglas MacLatchy, Sunrise REIT
John M. Atkinson, Thilman & Filippini
Greg Thompson, Thomco
Raymond J. Lewis, Ventas Healthcare Properties Inc.
Mary Culpepper, 800/994-0165 ext. 2679
www.microfridge.com
MOVE-N SOFTWARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2
Move-N Representative, 817/282-7300
www.move-n.com
NATIONAL INVESTMENT CENTER (NIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
410/267-0504
www.nic.org
OPUS UNIT DOSE SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
OPUS Representative, 800/228-5021
www.opusmedsystems.com
RF TECHNOLOGIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3
Lorna Miller, 800/669-9946
www.rft.com
SENIOR HOUSING NET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Brad Fuqua, 888/525-2546
www.seniorhousingnet.com
UNITED RECEPTACLE INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Greg Bondura, 800/233-0314
www.unitedrecept.com
VENTAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Raymond J. Lewis, 877/4-VENTAS
www.ventasreit.com
VIGILAN INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
800/443-1127
www.vigilan.com
YARDI SYSTEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Bonnie Novella, 800/866-1144 ext. 184,
www.yardi.com
, SEPTEMBER 2005
43
PRODUCTS & RESOURCES
■ The Memory Lane
Company, based in Lone
Tree, Colorado, in July
released a new line of
Connect and Reflect products that can be purchased
separately or together as part of
an integrated program for people with memory loss. The
Connect and Reflect Family
Kit includes a DVD (or VHS
tape), book, and CD—all
designed to foster connections
through reminiscence activities.
The kit uses brief stories about
milestone life experiences, singalong music and video segments, and book archiving activities that can be created and
shared with loved ones. For
details, go to www.memorylane
media.com, 877/963-6679 (8779-MEMORY).
■ Based
in Clarksburg,
Maryland, the Alzheimer’s
Family Relief Program
(AFRP), a program of the
American Health Assistance
Foundation, has released two
new informational brochures.
“Staying Safe:Wandering &
the Alzheimer’s Patient” is an
eight-page brochure that
addresses how to prevent wandering and what to do if a person is missing,
among
other
related
topics.
“Care
for the
Caregiver:
Managing
Stress” is a
12-page
brochure that
offers tips for
reducing caregiv44 SEPTEMBER 2005
,
F O R
er stress and practicing a positive attitude. Single copies of
both brochures are free.There is
a fee for multiple copies. Order
online at www.ahaf.org or call
800/437-2423.
■ With headquarters in Chicago
and Covington, Louisiana,
inFront provides tools for risk
management in the long-term
care market.The iQuest
Workforce Management Suite
from inFront features the iPoint
Intelligent
Controller,
which acts
as an access
controller,
time clock,
and data
capture
device.The iPoint will
accept any kind of identification
technology, including barcode,
magnetic stripe, or biometric.
The iPoint can be upgraded in
the field and additional units
can be added as needed. For
details,go to www.infrontusa.
com or request information by
e-mailing [email protected].
LeaderStat, based in
Westerville, Ohio, provides management staffing, executive
search, and consulting services
to businesses that provide seniors care and housing.
LeaderStat’s clinical and operational assessments provide feedback focused on enhancing
quality improvement initiatives.
Consulting areas include survey
■
A S S I S T E D
L I V I N G
management, recruitment
and retention, marketing and
census development, operations and administration, and
quality improvement.Visit
www.leaderstat.com for
more information or call
877/699-7828.
■ Based
in Woodbury, New
Jersey, Waste to Charity is a
501(c)(3) organization that col-
lects excess inventory from corporations, businesses, and individuals and supplies it to those
in need.The organization accepts
food, furniture, medical supplies,
clothing, office and school supplies, and vehicles, among other
items.Waste to Charity does not
charge donors or partner organizations for its services. For detail
go to www.wastetocharity.org
or call 865/456-4996.
BOOKSHELF
Time Mastery: How Temporal Intelligence Will
Make You a Stronger, More Effective Leader
By John K. Clemens and Scott Dalrymple
This book was released in June by AMACOM,
the publishing division of the American
Management Association.The authors say
leaders who understand that time isn’t a
management problem, but a leadership
opportunity, exhibit the critical skill of “temporal
intelligence.”They say it is a competency that can make the
difference between being a run-of-the-mill leader and a great
one. Time Mastery offers strategies for cultivating seven crucial time mastery behaviors, such as:“get and set an organization’s tempo”—synchronization techniques for achieving
individual, departmental, and organizational harmony and “go
beyond calendars and clocks”—methods for harnessing the
power of unscheduled moments and fast-approaching tipping
points. For details, go to www.amacombooks.org or call
800/714-6395.
The One Thing You Need to Know: … About Great Managing,
Great Leading, and Sustained Individual Success
By Marcus Buckingham
Released in March by Free Press, this book is written by a
social science researcher and well-known business consultant
and public speaker. Buckingham wrote the best-selling book
First Break All the Rules:What Great Managers Do
Differently in 1999. In The One Thing You Need to Know,
Buckingham identifies the traits you must learn about people
in order to manage them effectively, as well as personality
traits that all great leaders must possess. To read excerpts and
reviews, go to www.amazon.com and search by the book’s
title or author. ▼
BE HERE.
KEEP AN EYE HERE.
GUARD THERE.
CHECK THERE.
MONITOR HERE.
LOOK IN THERE.
WATCH HERE.
©2005 RF Technologies, Inc.
SAFETY THAT’S ALWAYS ON-CALL.
The safety and security of all your residents is of the
highest priority. For those at risk of wandering, your staff
can deliver the safe, secure care residents require without
infringing on the privacy and dignity they deserve.
Code Alert® Wandering Management stands strong as
part of an integrated safety solution that minimizes risk
while maximizing staff efficiency.
CUSTOMIZABLE AND SCALEABLE.
Comprised of multiple, easy-to-install and use monitoring
solutions, the Code Alert® family of products is
designed to deliver enhanced safety throughout your
facility — working in step with your policies and procedures
while allowing you and your staff to focus on the
ever-important task at hand.
CODE ALERT® Wireless Call
and Telecom Solutions
CODE ALERT® Wandering
Management Solutions
CODE ALERT® Fall Monitoring
and Incontinence Solutions
TESTED. TRUSTED.
With over 10,000 installations
world-wide, including long-term
care and assisted living facilities
of all sizes, Code Alert® provides a
total continuum of care that can
only come from years of experience.
Years that add up to an unparalleled
benefit for our partners. Code Alert®
delivers total peace of mind for
you, your staff and your residents.
Any time. Anywhere. For more
information, visit www.rft.com or
call 1-800-669-9946.

Assisted Living Executive Sept 2005

Transcription

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