The lines between senior living care levels have blurred in recent years as residents arrive at communities with more care needs, and as operators get more skilled in caring for them.
For example, it’s a common refrain in the industry that today’s independent living residents are yesterday’s assisted living residents; and today’s assisted living residents are yesterday’s skilled nursing residents.
The trend — sometimes referred to as “acuity creep — is not a new one in senior living. But with a seismic demographic shift around the corner that is sure to redefine the senior living industry, operators including Priority Life Care, Forefront Living, Chelsea Senior Living and Watermark Retirement Communities are looking to reestablish clear boundaries among care types, particularly between independent living and assisted living; and active adult and independent living. .
Part of that has to do with the fact that, without clear distinctions between care types, residents don’t always stay in them for long, especially if they find they actually need a higher level of care after moving into the community.
The need to create clearer lines among care types is underscored by the fact that baby boomers are thought to desire less clinical settings than their predecessors as well as more wellness-focused services. While operators implementing those services are undertaking them in part to better meet those needs, they are also seeking to boost length of stay and promote better resident outcomes at the same time.
To achieve those goals, operators are more clearly defining their services, amenities and care options for prospective residents, while maintaining a workforce that is trained and capable to handle higher-acuity residents.
Length of stay at an independent living facility could be a barometer of a community’s success in terms of wellness goals and engagement. Providers at the same time must also work to attract younger residents to senior living as active adult development grows and customers expect higher-level services and amenities.
Blurred lines between IL, AL
The erosion of boundaries between assisted living and independent living accelerated in the wake of the Great Recession as the housing market cratered and fewer older adults made the jump to a senior living community.
Residents without the ability to finance a move into senior housing stayed home longer than they wanted in many cases, sometimes for a matter of years. By the time they did move into a senior living community, they arrived with higher acuity needs than they might otherwise have. Over the years, that has led in some cases to average IL length of stay falling.
That trend is still depressing length of stay among independent living-heavy operators, according to Watermark Retirement Communities Chief Investment Officer Bryan Schachter.
Tucson, Arizona-based Watermark Retirement Communities manages more than 60 assets in 21 states ranging from CCRCs, IL, AL and memory care communities, along with rehabilitation and skilled nursing properties.
But while residents’ care needs changed over those years, oftentimes their desire to live in an independent living community did not. And that has led to a need among senior living operators to find more ways to allow residents to live in IL for longer.
Average resident ages among Watermark assisted and independent living communities has trended around 80 to 83-years-old, with many residents in the past straddling the line between needing IL and AL.
“We’re hoping to drag down that average age so that we have people that can really enjoy the amenities and services that we’re offering versus them being a fall away from needing to move to assisted living,” Schachter said.
Approximately half of the Watermark portfolio is higher-end rental, IL, AL and memory care; where length of stay for IL residents is around four to five years versus, Schachter said.
Priority Life Care CEO Sevy Petras said the industry’s swiftly changing demographics is forcing providers to cater to residents’ independence and freedom of choice instead of just their care needs.
“We have to meet them and give them what it is they want and show how we can support their independence at whatever stage that is best for them,” Petras said. “Each stage is different.”
Fort Wayne, Indiana-based Priority Life Care operates 39 communities across 11 states.
The ongoing demographic shift driven by the boomers will only spur future evolution in senior living care types, said Chelsea Senior Living President and Chief Operating Officer Roger Bernier.
Fanwood, New Jersey-based Chelsea Senior Living operates 24 communities across New York and New Jersey.
Chelsea typically co-locates independent living units alongside memory care and assisted living.He said the “sweet spot” for the company is incorporating 25 to 30 IL apartment units next to 80 to 100 AL units.
“They’re small and they stay full,” Bernier said. “Folks do transition but it’s not as quickly as you think. Those buildings stay full and that’s why we are so bullish on doing more.”
That was evidenced by Chelsea’s stable independent living occupancy throughout the worst of the disruption, which led to length of stay being greater in IL communities than AL, he added.
At Forefront Living, the company has expanded its IL portfolio exposure greatly since 2017, according to Forefront Chief Operating Officer Scott Polzin, starting with 191 IL units and growing it today to 365 IL units.
That comes even as length of stay figures for Forefront’s IL component have decreased slightly over time. Between 2012 and 2016, IL length of stay was an average of 7.74 years; and 6.3 years between 2017 and 2021. That’s an average length of stay of 7.03 over the last decade, Polzin reported.
Dallas, Texas-based Forefront Living operates a 66-acre senior living community that offers the full continuum of care. The operator’s IL occupancy has remained around 90% throughout the pandemic.
That is due in part to the increased ages of IL residents, with ages of IL residents at Forefront communities being nearly 5 years higher on average compared to a decade ago ago, Polzin noted.
Forefront is looking to attract younger residents with new amenities and programming, while giving new residents more opportunities to age in place, Polzin said.
For example, Forefront built an onsite physician’s clinic offering so residents could more easily access care services without having to leave independent living. And that should continue to boost the amount of time they can live in their current homes.
“Our length of stay will continue to increase as our programs keep residents active in independent living, attracting a younger resident because we have a lot of new products that are going to attract that younger resident,” Polzin said. “I’m optimistic.”
‘Active’ vs. ‘independent’
The active adult product type has taken the senior living industry by storm in recent years, with some likening its rise to the early days of independent living.
But that similarity also leads to confusion among some prospective residents and their families. The two words used to describe the product type — “independent” and “active” — are just similar enough that they can confuse consumers, even while the two care segments substantially differ in terms of price, services and amenities.
Watermark is “testing the dynamics” of an active adult community that it opened in 2021 alongside another community offering IL, AL and memory care, Schachter said. But the company is also clearly differentiating active adult and IL through different product offerings and services.
“We’re making sure that active adults aren’t cannibalizing independent living,” he said.
With active adult communities often appealing to a younger than the typical IL resident profile, Polzin wasn’t worried about the product type eating into IL margins in the future. But, it is something he is watching into the future.
“Right now they are not competing with this, but it will be interesting to see if they try to compete with this level of care in the future,” Polzin added.
Petras believes the active adult customer of today isn’t competing with IL simply because active adult residents are living different lifestyles compared to those in IL or assisted living, needing very little medical care or any general oversight.
“I think active adult really is more like that 63-plus and people are still very healthy and very independent moving into active adult,” Petras said. “As we move through Covid, all these different asset classes are starting to shake out ato figure out who they are and what they do best.”
Building clearer distinctions
As senior living operators seek to unblur the lines between care types, Petras sees an opportunity for senior living operators to cater to residents who don’t want the upkeep of an entire home; or those who desire both peace of mind as they age and socialization.
“It’s really about attracting people to say, come with us to be preventative and come with us so that we can catch things before you let it get too far out of hand,” Petras said.
Technology is another tool in bringing in younger residents and boosting length of stay. For example, Priority Life Care touts biometric data during the sales process to show residents they can live in independent living settings with added supports that can help keep them well longer and in some cases prevent them from needing to go to the hospital.
“I think that we’re about to be in a real boon from the utilization of technology with our vendor partners,” she added. “Technology can really add on the collaboration within our own communities to really help us give that longer quality of life.”
Watermark’s 360 Well program, on the other hand, is aimed at keeping residents’ healthspan intact for longer through wellness-focused dining, fitness, and education. With spend-down cards, Watermark residents can access various dining options, massages, personal training and other activities.
While this is not the program’s explicit goal, building in more lifestyle-oriented IL is also helping to maintain the distinction between independent living and other product types with higher levels of care.
“We’re looking at it more like a country club experience,” Schachter said. “It’s not completely unbundling our services like active adult but instead building in sufficient revenue through a monthly fee.”
At Forefront, Polzin said bolstering resident services, with a focus on wellness, was a key to future success building resident engagement and improving health outcomes.
And wellness programming is a necessity all providers must embrace, Petras said, as resident preferences change and as people live longer, healthier lives.
“I think we’re going to continue to see a trend of longer lengths of stay because people are not waiting as long,” Petras said. “I think we still have a ways to go. But people aren’t waiting as long to make decisions about the rest of their lives.”
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