Industry Innovator Carle: Future of Senior Living Hinges on New Execs, Housing Models, Tech

The Covid-19 pandemic has laid bare the senior living industry’s strengths and weaknesses. This moment in time provides an opportunity to change how the industry works — but it also poses a risk for companies that are too slow to adapt.

Just ask Andrew Carle, who has worked in myriad roles throughout the industry, from being COO of ALG Senior to working as an adjunct lecturer in the senior living concentration of Georgetown University in Washington, D.C., and even consulting with video game giant Nintendo during the launch of the Wii.

These days, Carle is the executive director of The Virginian, a Life Care Services-managed community in Fairfax, Virginia. Having had a front-row seat to perhaps the industry’s most challenging period to date, Carle has a good idea of what the industry needs to change to be successful after the pandemic.

“If we’re going to move the industry forward, we need experienced executives, we need new models of housing that people want to live in, and then we need these technologies to make sure we can run that,” Carle said during a recent appearance on the Senior Housing News podcast, Transform.

Highlights of Carle’s podcast interview are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts and SoundCloud. The interview took place in mid-August.

On how The Virginian has dealt with the Covid-19 pandemic:

It’s fluid.

We’ve all been dealing with this as an industry, and I’ve been monitoring it closely at The Virginian and through LCS, which has done a terrific job with this. At Georgetown — I work at the university, and they’re going through this —- I’ve got an obligation to stay on top of it in terms of our coursework and understanding.

The bottom line is this: It’s a pandemic. These things are hopefully rare for a reason. We’ve created safety islands. If you look at The Virginian, my community, we were the first full continuum community in Northern Virginia to get everyone vaccinated way back in January. Every single one of our residents, 100%, have been vaccinated for quite some time, and our employee vaccination rate is over 92%. So, we consider ourselves to be a safety island compared to the external community.

[Our residents] are an incredible generation of folks. They would constantly tell us, ‘It’s okay, you’re doing what you’re supposed to do, don’t worry about us.’ They were more worried about us some days and were reassuring us.

I think it drew us all closer to our mission, to why we all do this for a living. For pretty much a year, all we had was each other. And we became even more of a family in a lot more ways than we ever thought we could. So, behind every rain cloud, there’s a silver lining.

On The Virginian’s $56.5 million, tech-forward renovations:

LCS has the management contract, but the community is actually owned by a group out of Chicago called Focus Healthcare Group. They saw that this was a family-owned community for 40 years, and when the family finally decided to turn it over, they wisely jumped on it very quickly. It’s in an unbelievable location in the heart of Northern Virginia, it has 32 acres of green space, which … you know, you cannot find 32 acres of green space.

This is going to be a very high-end resort community, but with all the latest technology. They were also looking to really almost quadruple the memory care. I’ve got some background inmemory care design, so this was an opportunity for me. It’s a community that I knew, a community that I loved, but a community that was looking to reinvent itself. We are very serious about making this one of the premier senior living communities and a model in the United States of what a next-generation community should look like.

Any technology I can think of, they are very open about hearing about it. I happened to learn about Obie. It’s a projector in the ceiling, and it projects video games onto a tabletop or onto the floor. You can [also] do it on the wall if you want. It’s out of Israel, and it was actually invented for children. You see it in some food courts and fast food restaurants.

We are one of the first companies in the country to even have it. I happen to know their North America rep. He and I go back a few years in the tech world. And as soon as I saw it, I said, ‘Look, we’re going to pilot this.’ We set it up, we’ve had it up for about a month now and residents are really enjoying it.

You play with the motion. There’s nothing to set up, nothing to take down. You move your hands across the table. [For instance] you put the game on there and little bubbles float across the table and you pop them with your fingers. It has a couple of dozen games. They’ve got a Ph.D. gerontologist, Dr. Michal Herz, in Israel, who I’ve talked to. She was hired to reinvent some of these games and applications for not only older adults, but people with dementia.

On how Carle sees senior living technology evolving:

The irony is, I don’t consider myself a tech guy. I crash my own computer at least four or five times a year. But what I saw was what I call this great divide between geeks and grants. I knew that there were technologies that could improve quality of life for seniors, and I knew that we needed them. But I didn’t see the connections being made.

My real focus — even back then, 15 or 16 years ago — was that I felt very strongly we were going to need these technologies, which has proven to be true even more so than we thought, and even more so going forward. I might not understand technology, I might not understand how it’s built. But I think I have an understanding of how it can affect older people’s lives.

We’re not going to have enough people, by the way, to staff our communities. We need to do like the auto industry did and start automating. Eighty percent of the car you and I drive every day is built by robots. We’re going to have the same issue in senior living, so we need to learn to automate as well. So, there are a lot of applications for technology.

I continue to put these things into buckets. There is what I look at as resident-focused technologies. And then as an operator, I’m looking at operations- and service delivery-focused technologies. Sometimes, they overlap, but more often than that, you have to choose which bucket you are really focused on today. The resident-focused ones, like Obie, for example, [might include] virtual reality, which we have at The Virginian. On the operation side, it’s really about the infrastructure. What we used to call health IT is now health informatics, and it’s about predictive analytics.

We need to move past this static data tracking where we just would retroactively look at data, and then look for trends in whether we are meeting our benchmarks. We need to look at predictive analytics.

Can we predict UTIs? Can we predict falls before they happen? I used to have a colleague at George Mason University, brilliant health informatics guy from Poland, he actually created a program for the Veterans Administration where he could predict with 95% accuracy when a patient in a VA hospital was going to die within about 48 hours. It was really accurate. Of course, the real purpose of that was to prevent them from dying. If we knew that they were going to die and what was going to cause it, we could prevent it.

I think it’s about predictive analytics at the forefront. And then, you get into robotics, and it’s the ability for robots to not only predict the next steps, but to initiate them autonomously. These are the two big things that are going to drive pretty much the world’s technology. But we’re part of the world, and we’re going to need these technologies. We are mathematically eliminated from having enough workers, I have stressed this at so many conferences. Two million workers are not going to magically show up. We need to make one worker in the future as productive as three today, and the way we’re going to do that is with technology.

Look at McDonald’s. A few years ago, they came up with a Big Mac kiosk. They put it in one of the restaurants and people thought, ‘Oh, that was cool that the little kiosk makes a Big Mac.’ But what McDonald’s was really doing was predicting the future, which was accelerated by Covid. There’s not enough food workers, and they were trying to get their customers used to the idea that in the not-too-distant future, pretty much all your food behind the counter is going to be made by robots. 

Now, what we see in senior living is well, you need people for that. But if you break it down by functions, we’ve got robotic medication dispensers that make fewer errors than people, we have predictive analytics that can predict falls before they happen.

[There might be applications for] robots that can lift. They’re not complete assistive robots, they don’t do everything. But a robot that can do a lift — think about how many workers we lose to back injuries? The number one cause of a lost worker in senior living is a back injury. Everybody loses here: They lose their entire career, you lose a worker. If you’re an executive, what would you pay for that robot? A lot, and you’d still come out ahead if you think about how much workers comp and back injuries are costing you.

We need to focus on anything that eliminates steps or eliminates time, because that’s what our workers are doing. They’re either walking or performing a task that absorbs their time, so anything that reduces their steps or time is a good technology.

On how Carle got involved with Nintendo during the launch of the Wii:

I was in Sydney, Australia, in 2006. I was actually delivering a keynote at the 25th Congress on Aging. And one night I was bored, so I left my hotel, went across the street to a mall. And in the middle of the mall, they had a platform and some young people up there demonstrating the [Nintendo] Wii. I don’t think it had been released in the United States yet, but it was released on the other side of the world a little bit earlier.

I used to be a rehab hospital CEO, so my physical therapist had beat into my brain this whole idea of movement. Early on in my career, I used to write about what I called functional assisted living, which was getting people to get up and move instead of getting them their coffee, things like that. Today, we call it life enrichment and wellness.

When I saw [the Wii], I saw what a lot of people could see: low-impact range of motion — exactly what we were trying to do with our seniors. Wii Sports has bowling, golf, tennis, baseball; well, those are exactly the things that people did in their retirement. People were in bowling leagues for 10, 15 years, but the reason they stopped was they couldn’t pick up the ball. So, I just thought, ‘Oh, my gosh, this could really work.’

I contacted Nintendo when I got home. They were a little dubious, actually, because they don’t design it for that. But they said, ‘Talk to our PR folks.’ And so I spoke with them, and by the time I explained some of the demographics, and some of the numbers, all of a sudden I was a spokesperson for Nintendo, [which lasted] for about two years. Not only for the Wii, but for their Brain Age games, some of their cognitive games.

I got the prototypes — I was a big hero in my neighborhood, because all of these things would show up in my house three, four months before they ran on the market. My kids were the most popular kids in the neighborhood.

On why university-based retirement communities (UBRCs) are worth undertaking in a post-Covid world:

Both universities and senior living providers have been massively affected by Covid. Any time there’s a crowd of people gathering somewhere during the pandemic, that is an issue. But that does not change the factors that drive the demand for this.

Study after study has shown that retirees now want three things: they want to be active, they want to be intellectually stimulated, and they want intergenerational retirement environments. They do not want to live in what I call an “elderly island.” It doesn’t matter how beautiful the community is, when it’s out in the middle of nowhere and they have no access to the outside world — the gilded cage is still in the cage.

Think about what I just described: Active, intellectually stimulating, intergenerational. I just described the college campus, and these retirees have figured this out.

So, yes, they’re drawn to this. It offers exactly what they want, and it’s very good for the universities as well, to bring in these intergenerational populations. Every university has a mission to serve the community. Well, 20% of your communities are over the age of 65, you might want to be serving them. So it’s really a win-win scenario when it’s done right.

These are very complicated models, you cannot find two more different worlds than state universities and for-profit senior living providers. Because I happen to have the only academic program and I happened to be a senior living executive, I somehow ended up fluent in both languages. So a lot of the time, I just feel like kind of a U.N. interpreter just translating between these two parties — something that I think is very, very important to do.

On what the future holds for The Virginian and for the industry:

Like a lot of places, Covid certainly impacted [The Virginian’s] renovation schedule, which we’re really just now getting going on. We’ve done the outdoor grounds, which are spectacular, by the way. We’ve got pickleball courts, basketball courts, and an outdoor grill/dog park called “Central Bark.”

We’re really just getting started indoors. For me, it’s about continuing to try to establish these technologies and these programs moving forward with the Georgetown program. I think for the industry, we’re all in the same boat. We need more executives, and that’s why the program at Georgetown is so important. And we need experienced executives. The undergrads are great, but they need three, four or five years, post-graduation. We need executive directors right now.

We need more technologies. As I said, if we do not automate, we’re in big trouble. That’s why I’m so focused on new models of housing, like UBRCs. We need to build what people want. If we’re going to move the industry forward, we need experienced executives, we need new models of housing that people want to live in, and then we need these technologies to make sure we can run that.

[The immediate future] really depends on how quickly people get vaccinated. I think people are waking up to the reality now, snapping out of their denial. Go get vaccinated. This is a very, very highly contagious variant. It may not make you as sick, it may not put you in the hospital, but 99% of the people who are dying are unvaccinated. And if you’re in contact with them, that can happen. Of the very, very small number of people who have been vaccinated and died, unfortunately, a significant percent had been over the age of 65 or even 85. So, there is a risk there and we just need to stay on this. We can’t let down our guard.

Maybe we took a breath during halftime, maybe we’re now in the fourth quarter. This is going to peak probably in the fall, by most estimates. But if we continue to get vaccinated, we can bring this to a close much quicker.

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