Industry professionals gathered virtually to engage in the ICAA’s 2021 Forum focused on Wellness attracting the Middle Market. While building upon concepts that emerged from the 2020 Forum, attendees were charged to identify consumer persona attributes, discuss the benefits of leveraging the various dimensions of wellness and to strategize on opportunities for meeting the needs and aspirations of prospective residents, family, and staff. During the Plenary session, we were honored to share details surrounding our Wellpoint Community project alongside co-panelists Michael Tompkins of Hutchinson Consulting and Chip Conley of Modern Elder Academy (“MEA”).
Historically, the senior living sector has been slow to adopt new ideas or enabling technology. The wheels of change started to turn more quickly over the past decade due to increased focus on entitlement insolvency, awareness of Age Wave demographics and the regulatory paradigm shift toward value-based care where providers recognized a passive mandate to either Lead or Exit. While there are always outliers returning from the wilderness with bold ideas, meaningful collective progress in the Senior Living Industry has largely been moving at a snail’s pace.
Over the course of two days, it quickly became evident that there is a common journey underway where we all (professionals and consumers alike) are seeking greater meaning and choice from the communities that we design and/or choose to call home. While there is no question that the current emphasis on Wellness Real Estate favors a more affluent market, it seems evident that the systems approach that a true wellness offering demands will naturally preserve and/or reveal opportunities for all age cohorts and income classifications to come together and care for the larger self.
Insights from the Panel
Joseph McCarron – CEO of Wellpoint Community – described the kit-of-parts representing our prototype and business plan. A cornerstone of this strategy is to deliver an expansive menu of personalized program options. The confluence of senior living, integrative medicine, boutique hospitality and residential living on a single site promotes the convenience of access, choice and affordability. These attributes garner intergenerational appeal and create opportunity for the emergence of a genuine community.
Michael Tompkins’ career history and experience qualifications ideally exemplify the exhibiting convergence of healthcare and hospitality – two umbrella keywords that largely treetop the diversity of sectors representing the Global Wellness Economy. Having seeded his career in nursing care, his direct caregiving foundation and executive achievements position him to have a leading influence in combining and aligning these sectors while honoring the valued perspective of guests and staff alike.
Chip Conley has been playing a leadership role on the world stage for decades and the Senior Living Industry is fortunate to have gained his captive interest and ambition. As a repeat industry disrupter, he laid the groundwork for his current focus with the lessons he shared in “Wisdom at Work: The Making of a Modern Elder.” While ageism in the modern workplace can largely be addressed by honoring the experiential knowledge (wisdom) of elders, the broader detriments of modern culture do not appear to have any modern antidote. As he transitions toward helping to redefine retirement, his emphasis on championing “regeneration” with a biodynamic approach to “Regenerative Community” holds another possible lesson that we wish to amplify after offering some context.
What is Regenerative Agriculture?
Any phrase that is prefixed with “regenerative” can be contextualized by understanding the history of the regenerative agriculture movement. Charles Massey’s 2018 TEDxCanberra Talk provides a token example of the growing sentiment that reconnecting to nature and its wisdom is a prerequisite to healing ourselves. Simply stated, Modern Agriculture and Modern Medicine (Sick Care) are the culprits behind our dis-ease states. Are we sick largely because of the way we eat and the way we farm? What if reclaiming our knowledge and wisdom about nature could also help to reconnect us with our own health and well-being? While we have not yet had the opportunity to confirm the sentiment, it seems clear that Chip and other pioneering minds understand this to be true.
Everything in its Time
When the Global Wellness Institute (GWI) released their “Build Well to Live Well” report in January 2018, they helped to fortify an idea that had been germinating for decades without requisite support or nourishment outside of senior living. Creation and evidence-based promotion of the “Wellness Real Estate” and “Wellness Community” banners empowered them to leap frog competing green building interests and galvanize professional and public support towards recognition that our built-environment is likely the greatest determinant of our health and well-being. More specifically, GWI asserted that up to 80-90% of health outcomes depend upon the external and environmental factors in our “wellness ecosystem.” If you layer on to this groundswell of commercial real estate interest in wellness that “nursing homes” emerged as a crisis center during the COVID-19 pandemic, it is no wonder that so many Industry Stakeholders are finally focused on creating healthier spaces and places.
In a time where “wellness washing” is running rampant, we are all being called to under-stand and share the “what” and “why” of our approach so that others can feel the pull and participate in both the programs and their overarching purpose – to pursue higher levels of meaning, engagement, support, and activity together.
Everything in its Place
In their 2012 research article “Designing from Place: A regenerative framework and methodology,” Pamela Mange and Bill Reed offer that “Transitions to new worldviews ‘take hold’ as the new paradigms they give rise to become embedded across disciplines and fields of endeavor, increasingly being manifested as accepted standards, protocols and processes.” In this paper they are referring specifically to the paradigm of regenerative thinking and outline four criteria or gateways through which we must pass in order to complete this shift of thinking and being.
People must take their place again in nature and focus creative and economic activities toward the development of human potential.
A mental shift is required where we bring a “new mind” to the generative thinking that has shaped our buildings historically. In keeping with the natural order of the web-of-life memetic, we should conceive of our site, infrastructure, and inhabitants as dynamic and interconnected flows of energy.
We must cultivate enough eco-literacy to support such attempts at biomimicry.
Work developmentally toward constantly seeking the next level or relative hierarchy.
In a final nod of tribute to the relevancy of this important article, Charles Krone’s Levels of Work Framework is shared to graphically reinforce the sentiment that evolutionary processes (potential) will never be engaged if you are only operating within the explicate order of maintenance and operations.
Whether we are referring to our culture, our industries, our business or even our own cellular structure, we are reminded of the requisite balance between chaos and order that defines all complex adaptive systems (nature). If we want to attract any market to our “Wellness” offerings we should first focus on an organic approach where we lead with authenticity and diversity of choice/offerings.
Takeaways
The Forum proved an engaging event that bred genuine enthusiasm and creative thinking surrounding the change scape represented by the Senior Living Industry.
Lifestyle offerings that promote enriching lives and active engagement will augment if not supplant the traditional provider focus on ageism and supportive care alone.
New business models responsive to consumer choice will continue to prove threatening to the traditional senior living communities.
Flexibility and choice of offerings will foster growing collaboration and convergence of all stakeholders in aging services.
Emerging from the devastating consequences of the COVID-19 circumstances is a heightened awareness and demand for “living well” at home with catered service offerings. At the same time, opportunities for meaningful social connection (digital and In-Real-Life) are critically important. The Senior Living Industry is ripe for leading a strategic societal redirection given these exhibiting trends and the profoundly changing consumer profile.
A consumer centric strategy will require more education, integrative thinking, and execution that pioneers a balance between self-care, social wellness and eco-literacy.
Consumer needs, preferences and expectations mandate a dramatic new approach to real estate development and operational programming that is highly personal, modular, adaptive and cued by progress toward the new “future of medicine.”
We advocate “Redirecting” and “Cultivating Convergence” for the future of aging services – “Where It All Comes Together”. Undoubtedly, dramatic change abounds. If adversity truly breeds opportunity, change agents alert to new directions stemming from “systemic” and “holistic” strategies more aligned with the “natural order of things” are poised for great success.
On October 25, 2019 The Age Friendly Foundation launched its inaugural Revolutionize 2019 Conference Event held at the Seaport Hotel in Boston, Massachusetts.
The event was co-sponsored by the Boston Chapter of Aging 2.0 and
included over 300 attendees representing a diverse forum
of business and industry stakeholders engaged in aging services. The Foundation was established in late 2018
as a vehicle to augment the continued growth of the Aging2.0 Boston Chapter’s
programming together with related advocacy, education and events that champion
healthy, active and productive aging for all ages.
Recently named the Silicon Valley of Aging by
Inc. Magazine, Massachusetts provides an ideal backdrop to this international
conference event promoting innovations in aging. As a center of pioneering research,
education, healthcare, technologies and public policy, Boston is the perfect
host to Revolutionizing the “Future of Aging”. Revolutionize 2019 represented a
diverse assembly of “Best-in-Class” thought leaders coming together with
integrative intentions.
SHARING MOONSHOTS
When the “Revolutionize” theme for this Fall’s
conference was seeded, we reflected on the humbling reality that early American
colonists were relying upon hand-written letters or printed pamphlets that had
to be carried by horseback or ship in order to share knowledge with cities and
the rural lands where so many lived. The Committees
of Correspondence that were ultimately formed and networked could arguably
be credited for our ultimate success in organizing for Independence. Fast forward to today, where technology
empowers us to connect instantly across the globe and it follows that we should
be able to advance any common cause with ease IF we pursue it together. Successful
outcomes naturally hinge on our ability and willingness to adopt shared language
(or data) and ensure its “interoperability” for all stakeholders.
Simply stated, the common cause for this
inaugural year of Revolutionize is to transform our views and practices surrounding
so-called “aging services” in an even more inclusive and progressive
fashion. The consumer profile underlying
“senior living,” and or “age-tech” designations are profoundly changing – induced
by unprecedented longevity and clearly emerging preferences for wellness, lifelong
learning and active engagement that unifies rather than divides. Conveniently,
this shift amplifies the needs and desires of all age groups and all 8,000
day life stages in our emergent Four
Generation Society.
Key attributes of this new landscape will exhibit
growing intergenerational presence, new technologies, progressive programming
and escalating capital resources to support healthier, active and enriched
lifestyles for everyone.
SOCIAL INCLUSION
In his opening keynote, Dr. Alexandre Kalache set the stage for a new chapter in the Age Friendly Movement by amplifying the theme of growing inequality (economic, racial, gender, age-related) across both the United States and world stage at large. His remarks inspired us to acknowledge that we can likely accomplish even loftier goals if we focus on macro issues like social inclusion but approach them from a micro (local) perspective. This insight (arguably inspired by his formative role in the Age-Friendly Cities program) amplifies recognition that a bottom-up process is most effective when you are trying to turn the wheels of change.
The WHO Global
Network for Age-friendly Cities and Communities currently includes 1000
cities and communities in 41 countries, covering over 240 million people
worldwide. On April 12, 2017, Governor Baker signed Executive Order 576
establishing the Governor’s Council to Address Aging in Massachusetts and the
Commonwealth became the 2nd state in the nation to enroll in the AARP Network
of Age-Friendly Communities. During his 2019
annual State of the City address Mayor Walsh announced the launch of the Age
Strong Commission (previously known as the Commission on Affairs of the
Elderly). More recently, he has launched the AgeStrong Public Awareness
Campaign to further support awareness of inclusion and the fall conclusions of an
ageist perspective:
While the general eight-domain
framework (branded by AARP as Livability)
dovetails with many other overlapping standards, it is the policy connection,
action plans and subsequent traction in the City of Boston, State of
Massachusetts and across the country and globe that makes this movement
noteworthy and deserving of active acknowledgment, promotion and advancement.
DON’T TREAD ON ME
When Dr. Joseph Coughlin took to the stage to
close the event, he challenged the audience to take up arms (metaphorically) at
a deeper level. If we want to
“revolutionize,” it follows that we ought to be truly revolutionary in our speech
and in our thinking. He proffered further that specific words, like
Age-friendly, Livable, Caregiver & Mobility ought to be abandoned as we
charge ahead. While words do matter, we
advocate that recognition should be given to those that have already taken root
in our communities and represent progressive movements to be expanded upon. Age Friendly primary among them.
In reflecting further upon the attributes of a
true “revolution,” Coughlin cited that signs and symbols are typically at the
epicenter of all social movements. The best symbols are often simultaneously
generic and descript in their messaging so that a majority can rally to its
messaging in a more personalized way that still honors the collective intent. The
revolutionary symbol of “Don’t Tread On Me” comes to mind where the pictorial
snake mantra of “Join or Die” for the 13 colonies is juxtaposed with the more
deeply rooted anthropomorphism of a Rattlesnake and its deadly bite when
threatened. In a modern era where corporate or personal branding has taken
precedence over the tribal markings, tartans or nation flags of old, what is
the next banner we might wave intentionally as a collective humanity?
FORWARD MARCH…
Revolutionize denotes initiatives to effect a
radical change to existing conditions.
The dramatic change landscape exhibited by aging services and all its
influencers is replete with opportunities yet burdened by challenges. We can be the change agents analogous to our
revolutionary forebearers – marshalling everyone together in a common cause –
to deliver upon recognizing that aging is a national treasure rather than a
burden to carry. Fueled by knowledge,
experience and tools of advancing technologies, we can indeed foster the
requisite collaboration for a forward march and be the catalysts for
convergence to reimagine and redirect the future of aging – for all ages!
The UMBC Erickson School’s 7th Annual Memory Care Summit in Orlando delivered on i`ts promise “to transform thinking about memory care.” This year’s program theme of “connections,” was inspired by Dr. Judah Ronch’s presentation surrounding brain science and neural network mapping. His message was clear. Each of us are entirely unique by virtue of both the memory formation and retrieval processes. In fact, even a singular memory becomes layered with individuality as it is compounded by recollection. We left the conference focused less on the hard science of 3D brain scan imagery and more on the natural rhythms of engagement – and how active awareness and recognition of this process can lead to higher states of order. Whether we are talking about people, projects or memes themselves – multiple associations will always create resiliency. This continuously programmable framework helps to either sustain or redefine our elusive and ever-changing concepts of “self” and “other.”
Connectomics
While recapping the conference in prior years, we have always emphasized the intentional bookends crafted by The Erickson School. Dr. Ronch launched the first day by reflecting upon the concept of the “connectome” and how its lessons can help us to improve and expand upon the culture change movement that is still underway. In essence, person-centered or person-directed care is not just a good idea – it is an elevated approach that honors the power and persuasiveness of partnership.
If you are not familiar, the Human Connectome Project represents the scientific moonshot of mapping the neural pathways in the brain of healthy adults. Sebastian Seung’s popular 2010 Ted Talk, “I am my connectome” introduced this concept to a mainstream audience:
Did you know that our connectome is presumed to be as individual as our genome? If you want to learn about the staggering complexity of this mapping project and where we are collectively in the research process, please find time to view the “Cartographers of the Brain” panel from 2017’s World Science Festival:
Our biology is so incredibly (and infinitely) complex, as each of the panelists attest, that any expert worth their salt is humbled by its study. Nothing we have created to date can compete with the technology of nature. In a time where man-made technology is revered, it is important to acknowledge how little we know about everything.
Designing with Intention
The Disney Institute’s Program Facilitator, Mark Matheis conducted a behind the scenes tour of the Magic Kingdom for us after an introductory presentation. When you learn about the Disney Culture, it is always emphasized that they have “learned to be intentional where others are not.” While walking down Main Street, we were educated on how this philosophy manifests in practice. All design elements work together to reinforce a positive experience for guests of all ages and backgrounds.
At the surface level of Main Street, every architectural and operational detail influences our behavior and engagement with the environment. Literally, just beneath the surface, a vast network of infrastructure sustains the quality and nature of that street-level experience. Disney understands what people of all ages hold in common, but they also strive to capture and account for our uniqueness. This is accomplished by combining cultural and psychological influences and establishing something that appears to be uniform but has been aggregated from the broadest spectrum. For example, the building facades borrow something from architectural styles around the world. Wherever you’re from, it is possible for you to feel at home on Main Street.
Yes, And
In a standout session led by Erickson graduate Donna Poole and her daughter Jessie, we were introduced to their personal experience connecting caregivers with the lessons of improvisational theater. If you are already familiar with this coupling, please share it broadly. We would also recommend reading Yes, And, and viewing the 2018 NIC Talk by Kelly Leonard:
There was a palpable change in the audience during this particular session because of how impactful it was. We were all intensely moved by their story and its delivery. The quality of observations from attendees during the Q&A seemed to affirm that we had all literally been uplifted – especially in our collective thinking. When we first started talking about the “connectome”, we were looking at images of the brain alone. Someone suddenly made a loose (almost transcendent) comment about the presence of memory outside of the brain for the first time since the Summit began. As Deepak Chopra consistently relays,
“Instead of conceiving reality from the bottom up, moving from tiny building blocks to larger and larger structures, one could do the reverse and create a top-down model. In other words, the starting point would be the whole, not the parts. So what do we know about reality as a whole?[1]”
It is legitimate to focus on the brain and its immediate connectome, because we must start somewhere. Let’s just not forget that we have mountains to climb! There is a larger question about consciousness and the nature of “mind” that needs to be addressed.
A Call to Mind
We view the founding Erickson mission of combining aging, management and policy as being more timely now than ever before. Recalling that enduring progress does take time, there is finally a clear opportunity emerging from the groundswell of interest and legislative traction related to the Age-Friendly Movement. Whenever keywords surrounding the World Health Organization’s Network, Livability or up and coming building/occupant performance standards like, WELL or Fitwel surface, we are both excited and disheartened. Excitement exists because we believe in the power of shared and comprehensive frameworks to transform culture. We are disheartened because we also recognize the power of babel. There are so many competing standards and movements in our industry alone – let alone in and across other sectors and geographic boundaries. If we really want to “connect,” a unifying banner is imperative.
For the first half of the Summit, the Age-Friendly movement surfaced a few times as a talking-point. After Donna’s session, we started to make open reference to its all-inclusive nature. Just as the mind, memories and our personal identity transcend the physical brain, Age-friendly is not about “Older Americans” alone. It is (at least we hope) about being “mindful” of how to integrate everyone within an intentionally supportive community infrastructure. As the lead for WHO’s network in the United States, we commend AARP for positioning this standard as “livability” – with relevance to all ages. We should not have to visit Disney World to experience the magic of Placemaking or Building Healthy Places!
The State of Emergency
On day two, newly appointed Secretary of Elder Affairs, Richard Prudom, enlightened us about the scope of planning and coordination undertaken by the State of Florida for disaster planning. Together with Kathryn Hyer, Ph.D., representing the Florida Exchange Center on Aging, we witnessed a compelling case study surrounding the state and local collaboration responsive to recent hurricane disasters.
Emergencies are local and so too are the resource needs responsive to them. While considering the relevance of this program to the Memory Care Summit, the analogy emerges. Our industry is replete with diverse and disparate resource outlets represented by a myriad of constituents. Leadership influences are required to “connect the dots” and marshal alignment responsive to our own State of Emergency – the Future of Aging. If we want to support and augment critical public services, we should strive to become more familiar with their delivery frameworks and actively seek opportunities to leverage common language and structure.
A Quixotic Quest
A Hallmark of the Memory Care Summit is the final book-end of a human interest story – typically a first-person account from someone living with a Memory disorder. These stories are often heart wrenching and reinforce why we are in the business we are in. More importantly, the heart strings pulled remind us that this is not really a business alone – but more of a societal journey where we are all on a heroes’ quest of sorts together.
Brian LeBlanc is an International Dementia Advocate. In his own words, his personal mission is to act as a voice for those who are no longer able to speak. Brian allowed us to look inside his own experience with early-onset of dementia. He juxtaposed the active eloquence of his delivery and poise in speaking to us with a recent and personal video recording that captured an airport episode of what he characterizes as a fog – when the symptoms of his dis-ease are being expressed. The contrast between the energy of the gentleman presenting to us and the man we could observe being lost on screen was stark beyond words. In his closing, Brian read the Impossible Dream to us and asked that we listen through a particular lens – What if a Cure for Alzheimer’s was the Impossible Dream?
The Impossible Dream lyrics: Lyrics by Joe Darion In this song, Quixote explains his quest and the reasons behind it … in doing so, he captures the essence of the play and its philosophical underpinnings. (For me, it
Catalyst for Convergence
In reflecting upon the theme of the Memory Care Summit, we consider the broad implications this has on our industry at large. The Summit, with its diversity of program content and participants, proves a stellar example of research, education and practitioners coming together and making connections. This seemingly proves the formulary for moving forward – where we recognize and embrace the individuality of all stakeholders in this journey and the value proposition represented by all knowledge and experiences – taken together and appropriately combined. While connecting the dots seems daunting, coming together and collaborating on the opportunities and obstacles ahead is undoubtedly the prudent path of achievement. This is the essence of integrative thinking that is championed by the Erickson School and its programming. The Memory Care Summit is perhaps the microcosm illustration of this universal solution. As before, the Summit fuels our own thinking and continues to inform our own direction.
Systems and processes that we design with creative intention are the true enablers of engagement and progress – but they don’t create impact overnight. The Disney Organization and its Institute have been fine-tuning and memorializing their own leadership best practices and operational expertise for decades. Any attempt to model the end-result of all their learning would be quixotic absent a commitment to do the work!
What would the world look like if we could live, work, play, stay and age well in States of America that were truly United? The first step is to embrace a “Yes, And” mentality. The gears of policy, management and aging will not turn on their own – and certainly not in isolation. The Memory Care Summit induces our thinking about the value not just of creating relationships but also on cultivating them with purpose and humility. Connections – like the teeth in a cogwheel – make forward motion possible one increment at a time. Programs like The Memory Care Summit help to pave the way!
[1] Chopra, D. (2019). Can There Be a Science of Consciousness?. [online] Deepakchopra.com. Available at: https://www.deepakchopra.com/blog/article/5791 [Accessed 4 Feb. 2019].
CBS reporter Harry Butcher coined the phrase “fireside chat” to capture the informal and conversational tone of President Roosevelt’s speeches during the Great Depression. History reminds us that the President wanted to speak plainly to as many Americans as possible. At that time in the 1930’s, nearly 90% of the country owned a radio and this medium offered an unprecedented forum for reaching the masses. During the opening remarks of Aging2.0 Boston’s Fireside Chat, Massachusetts Secretary of Elder Affairs Alice Bonner honored the tradition of speaking simply by soliciting a commitment from the audience. She recognized that while we were all gathered at District Hall to celebrate the promise and opportunity for a shifting vision of old age, retirement and enabling technology, there was a more pressing priority for us to seize together. IF we recognize that aging is about families and community more than it is about “old people” alone THEN, we are quickly reminded that kindness and relationship-building represent the greatest investment of “human” capital into our shared future. More literally, we were asked to make eye contact and say hello to the people we encounter in our daily lives – especially seniors seemingly alone.
With that segue in mind, the event’s Moderator, Boston Globe reporter Robert Weisman, guided an inquiry into the many insights offered by Dr Joseph Coughlin and his AgeLab team in his newly published book, “The Longevity Economy.” At the surface level, it is a book that encourages business leaders to think differently about how to position for a demographic certainty that almost “defies description.” At a deeper, more functional level, Dr. Coughlin and his team have leveraged their own brand identity and intellect to help change the conversation about aging and old age. As contextual history emerged through the fireside conversation it became clear that AgeLab has a broad and active charge – to help create an “infrastructure of wellness.” MIT is uniquely positioned to support delivery of a wellness framework to communities given that they stand at the crossroads of so many industry constituents. None among them can offer wellness alone – this outcome will only be achieved through active collaboration and convergence fostered by all champions of change.
Driverless thinking
At one point in the evening’s Q&A session, an individual asked about the promise of the Autonomous Vehicle (AV) industry. The AgeLab doesn’t just have a front row seat for observing this trend – they are actively working with Toyota (among others) to advance an understanding of how drivers respond to the increasing complexity of our modern “operating” environment. But wait – here is the rub – in response, Dr. Coughlin emphasized that in spite of all the deep learning and research underway, no one is focused (to his knowledge) on “the 20 foot” challenge. In other words, while billions of dollars have been invested in this trending technology, the functional issue of getting a person with limited mobility into or out of a vehicle has not yet been fully addressed! This single insight serves as a metaphor to the shortcomings of mainstream marketing and product development strategies. When you go the extra mile and think about the problems that you are aiming to solve from multiple perspectives, you will naturally uncover a deficit that leads to greater opportunity. To echo Secretary Bonner’s insight – let’s be sure we are investing resources into the “right” opportunities.
Hubs
The “PieterExplainsTech” YouTube channel offers a variety of tech inspired explainer videos. In Hub, Switch or Router, the viewer is introduced to three network devices (as titled) and the way in which they connect to each other. When we think of the phrase “Hub” from a layman’s perspective, it conjures the spirit of scale and connection. Imagine the wooden wheel from tinker toy sets that empowered us to make a thousand iterations of ultimately the same thing. It is not surprising that coworking studios, or other Victor Hwangenthusiasts, would gravitate to this “hub” language when seeding their own role in a burgeoning innovation ecosystem. True to form, real insights require deep thinking – a natural extension of the consumer-centric, systemic design thinking that the AgeLab represents. From a literal perspective, Hubs in a network do not distinguish or direct signals intelligently – they only replicate and push data through the network while increasing the bandwidth of our systems in the process. Switches and Routers on the other hand, make it possible to direct information more purposefully.
Switching and Routing
We are living in a time where every industry sector touts (often with their own unique sound bites) the merits of integrative or interdisciplinary thinking and yet even a cursory inventory of these vertical spaces reveal gross intellectual redundancies. We borrow thought leaders and pass them through our conference circuits but we do not always stop to consider the efficacy of our economy, business models or community landscape. The “city” historically has been a mechanism for creating and distributing goods and services and it accomplishes this monumental feat by consuming our human scale. Absent progressively planned community infrastructure (let alone serious inner-engineering), we cannot even begin to think about achieving and distributing the dimensions of wellness at scale.
We could not dismiss the subtle irony of sitting in District Hall – an incredible public innovation space that is literally dwarfed by the Boston Seaport cityscape – while sharing sentiments about an altered future state. Our western culture is so highly fragmented because our economic landscape requires it to be so. The appealing catchphrase “infrastructure of wellness” implies that there is (or should be) a dynamic delivery system supporting the attainment of well-being. Dr Coughlin and others focused on “longevity” always ask (appropriately) if we want to just live long or live well. It seems as though we will always fall short of this latter goal if we continue to commoditize and externalize our health and the attainment of wellness while still developing communities for cars and commerce rather than for people and relationships.
A Silver-Lining for “Senior” Living
There are literally hundreds of thousands of industry constituents focusing on the same problems. If we learn to share our language and outcomes, we will begin to close the gaps in our learning very quickly. Organizations like the MIT AgeLab offer the promise of integrative thinking fueled by collaboration – enhanced by the authority and influence they represent. If we don’t know who we are meeting on the sidewalk – there is something wrong with the city or town we are living in. This is our 20 foot problem! Living alone together breeds lost opportunities for truly redefining and redirecting the future of aging where we can live long AND well!.
It is not likely that conventional cities or towns can be repurposed overnight. Nonetheless, The Senior Living Industry is uniquely positioned to influence this change landscape – dismantling the senior silos of traditional real estate development and introducing planned communities that are more purposefully connected to the broader community. Thought leaders like Dr. Joseph Coughlin and his team remind us that the future has not yet been built. The infrastructure of wellness represents a future scenario that might organize itself with greater clarity of purpose with a shared vision.
Like most of you, we have attended a lot of conferences, workshops and seminars since entering the “Senior Living” sector. As repeat attendees of The Annual Memory Care Summit and representing a graduate of The Erickson School, we have one single expectation from the UMBC Aging brand and team – delivery of academic and person-centered content that can “excite and delight” business as usual. We use that phrase intentionally because our own team has just finished a group read (on Audible – our go to “employee training” app) of Joseph Coughlin’s “Longevity Economy.” Coughlin, introduces – among several other things – the concept of “transcendent” design where we focus on developing consumer products that will excite and delight all ages and not seniors alone. He encourages all of us to embrace what we would consider a “strengths-based” approach – where we design products for ability and inclusive opportunity rather than trying to solve problems that only highlight deficits in the targeted end-user. This kind of thinking should apply equally to our planned communities and programming.
“Our heritage and ideals, our code and standards – the things we live by and teach our children – are preserved or diminished by how freely we exchange ideas and feelings”
–
Walt Disney
American entrepreneur,The Walt Disney Company
We are entering (or perhaps returning to) a new chapter in our Industry and culture where the curse of knowledge (in business and clinically) is being replaced by an emphasis on the fundamentals of imagination and relationship-building. What kind of future would we imagine, and then build, if we focused more exclusively on engaging across generations and sharing stories, experience and knowledge to that universal end?
Imagination vs Experience
If last year was about creating magical moments, and fine tuning company culture for sustained results, this year offered the charge to advance our Iconoclast Quotient (IQ) in recognition that while “Logic will take you from A to B, Imagination will take you anywhere.” Ideas and Interests are converging at an accelerated pace. If we want to offer health and wellness services to family, staff and residents, we will be required to meet our customers (all of them) wherever they are – and it will take the whole village to support their wants and needs effectively. In the past we have relied upon experience to light our path. In the immediate future we all need to be trailblazers of some degree.
Heroism and Incrementalism
In typical Erickson School fashion (this is the academic influence) a series of “pre-reading” materials were circulated via Dropbox to attendees – among these was a link from Bob Kramer of NIC to a recent New Yorker piece entitled “ The Heroism of Incremental Care” In the article, Atul Gawande shares an interesting metaphor surrounding the collapse of the Silver Bridge in 1967:
“The collapse signaled the need for a new strategy. Although much of the United States’ highway system was still relatively new, hundreds of bridges were more than forty years old and had been designed, like the Silver Bridge, for Model T traffic. Our system was entering middle age, and we didn’t have a plan for it.”
In this essay, emphasis was tied largely to the dichotomy of surgeons (heroes) and primary care physicians (incrementalists). For our purposes here, the relationship between outdated transportation infrastructure and our own bricks and mortar in Senior Living is key. We all know that we are developing products that are designed around realities/constraints and beliefs that are no longer relevant – like the Model T – and yet we still charge on without reconsidering the viability of our footings. It is worth emphasizing that EVERY time a guest speaker has joined the stage (we have been to four of the six events) they are emphatic about not wanting our “products or services.” We clearly need visionaries and iconoclasts to chart new courses for our Industry where we focus on engagement instead of behavior management alone.
5 Leadership Lessons from The Disney Institute
As leaders in the “Imagination” department, Mark Matheis offered the Disney Company’s’ perspective on how best to execute your plans once imagined:
Leaders establish, operationalize, and sustain the values and vision by which their organizations thrive.
Great leaders proactively establish values.
The more a vision can be expressed in a vivid, imaginative way, the more it will motivate people to action in the present.
Storytelling is an essential strategy for the communication of new ideas; people are more engaged and inspired by information presented through compelling narratives
The best legacy is not one that is fondly remembered, but one that is actively emulated
Value is created when Silos Break down
In “What the Smart Money Wants from You,” Robert Kramer, Founder & Strategic Advisor to The National Investment Center for Seniors Housing & Care, shared Industry Data and offered his own insight toward three drivers that are influencing our vision and narrative for the future:
The Longevity Revolution (Silver Tsunami)
Data, Robotics and Mass Customization
Healthcare Payment & Delivery Reform
“We always overestimate the change that will occur in the next two years…and underestimate the change that will occur in the next ten”
–
Bill Gates
American business magnate,Microsoft Corporation
In his engaging presentation, Bob Kramer offered his invaluable insight (replete with data metrics of course!) into the future of aging, how it is being redefined by emerging trends and the anticipated impact of “new retirees”. The later will be represented by “transitions” to encore professions as opposed to traditional retirement. Bob’s own circumstances are illustrative of this occurrence. Having been recognized as the CEO leader breeding the remarkable success of NIC as the premier research, educational and data source for the Seniors Housing & Care Industry, Bob now transitions to Chief Strategist for NIC. Undoubtedly he, like numerous other industry veterans, including the likes of John Erickson and Dr, Judah Ronch representing the Summit, will continue to influence and shape the future of aging. These are not declinists but rather industry treasures to engage and leverage.
The Declinist view of Retirement where seniors unplugged to enjoy their golden years is clearly outdated (like the Silver Bridge) and being replaced by a new emphasis on engagement where residents will want to be become integrated with the communities they choose in an intentional and productive way. As the “diaspora” of healthcare continues and senior services become “uberized,” it will become increasingly difficult to compete with the demand for full service and retail “life management” solutions. Lifestyle coupled with the presence of supportive care proving more intergenerational and “connected” will give rise to the trends of desire trumping needs. Where will we plug in to the new value equation as developers, operators, caregivers? Imagine a future of aging where business constituents are more “collaborative” than “competitive”. These trends are the leading indicators of integrative thinking (points from Dr. Ronch) and more integrated business models that emulate the real world.
Imagine a Cure for Alzheimer’s, Then What?
Scott Townsley’s session was centered around the assumption of a cure for Alzheimer’s. Whether or not a cure is on a horizon, this kind of open-ended / creative thinking enables us to focus on the survivable (or missing) attributes of our business and its offerings. Ironically, these attributes or amenities might actually define our core because they are likely “transcendent.”
“People don’t want to buy a quarter-inch drill, they want a quarter-inch hole”
–
Theodore Levitt
American economist and professor ,Harvard Business School
The traps of quality and superiority were addressed where the former represents the sentiment that well established organizations don’t need to change (until it is too late) and the latter assumes that a premium offering will also maintain its hegemony – except that customers ultimately crave simpler, cheaper incumbents. The final ¼” drill trap presented echoed the detriments of Marketing Myopia where we forget that we are selling solutions not widgets. If we are struggling to identify our own value proposition as an organization, this exercise creates an opportunity to highlight (and work to close) the gap between what we think we are selling (i.e. memory care) and what the market wants to purchase for themselves or loved ones (valued relationships and engagement).
Awe – using art to create relationships
If you are not aware, The Erickson School strategically front-ends the program with business and academic content and reserves the final book-end for local guest speakers that can help to ground and synthesize our thinking (by tempering it) with the raw emotional reality of people and their own first-person caregiving stories. Just before these guests arrived, we were primed for the transition through Anne Basting and a re-telling of her incredible work. She relayed how her experience of introducing the transformational power of theatre to people with memory care issues enabled them to engage instead of being alone together.
“The arts are a way of being in relationship, of seeing and shaping the world. My work brings the tools of imagination and creative expression to care relationships and systems in order to foster healing through community building. We cannot heal without story”
–
Anne Bastings
Artist, Scholar, Teacher,UWM Center on Age & Community; Founder, TimeSlips
It should not be surprising that an entertainment giant like Disney would proffer the same insights garnered from improvisational arts. Storytelling creates a safe space for everyone through abstraction – when you create an open environment, expression naturally fills the vacuum. What does this look like in the built environment? Or is architecture just a shell if it is filled with genuinely human activities? In any case, the challenge is not just how do we create a better physical space for Memory Care but rather, how can we establish a broader network of engaging human activities? We need life centers where everyone can thrive.
Short Circuits
To echo Atul Gawande’s essay once more, “Our ability to use information to understand and reshape the future is accelerating in multiple ways.” He continues to describe that “we have at least four major data inputs that reflect our health and wellness over time, (1) information about the state of your internal systems (from your imaging and lab-test results, your genome sequencing); (2) the state of your living conditions (your housing, community, economic, and environmental circumstances); (3) the state of the care you receive (what your practitioners have done and how well they did it, what medications and other treatments they have provided); and (4) the state of your behaviors (your patterns of sleep, exercise, stress, eating, sexual activity, adherence to treatments).”
When you consider the scope of these inputs, it becomes clear that we will need more bandwidth to capture all of this data and make use of it in a meaningful way. It is unlikely that a sole “hero” provider will venture off into the forest and return with a miracle solution for Alzheimer’s or any other dis-ease. Of course, if you have eyes to see and ears to hear, we might already be the miracle we are searching for.
“Remember, creative power will not operate itself. Knowing what to do is not enough. You, imagination’s operant power, must be willing to assume that things are as you desire them to be before they can ever come to pass.”
–
Neville Goddard
Author and Teacher
In this sixth year of the summit, we were all called to cultivate our iconoclastic quotient (IQ) so that the future we imagine is built on solid ground instead of crumbling foundations. We were also reminded that if engagement is the ultimate prescription, then we cannot succeed in isolation. Let’s take inventory of our respective strengths so that we can catalog and distribute the dimensional inputs of health and wellness together as due-diligence only. The shared moon-shot is to leverage the data and best practices to craft a new story about how we can age more actively and remain engaged together.
MeHI has been working closely with the Executive Office of Health and Human Services (EOHHS) and the Baker administration to advance the digital health ecosystem and explore how these new technologies can improve healthcare in the Commonwealth. Last week’s Reverse Pitch event was a first of its kind event for Aging 2.0 Boston. Under the leadership of Tim Driver, our chapter’s new Ambassador and 2017 Influencer in Aging, our planning committee sought to co-organize a uniquely themed event that might pave the way toward a protypical networking experience focused on casting a wide net and solving real world challenges.
What have we learned? Savvy business leaders are beginning to realize that much of the scaffolding for innovation has already been built by digital giants and the entrepreneurial community. Connectivity to these resources is lost absent more integrative thinking that rescues one from a siloed context. Mobile technologies in particular are seemingly ubiquitous and often designed for a broad array of user personas – not just boomers or seniors. There is an obvious silver lining here when we step outside of our aging services vertical – and allow ourselves to be informed by what we see in app stores, Kickstarter,Indiegogo and directories like Product Hunt. – we are reminded that many so-called industry-related problems are really just universal human problems in disguise. More importantly, many of these challenges are already being solved (or at least addressed) in adjacent spaces that are unencumbered by the concept of age cohorts.
How might we better connect the dots and foster more integrative solutions? Herein lies the opportunity contemplated by the Aging 2.0 Boston Reverse Pitch event where provider constituents in the field of Aging Services engaged in discussing how “new” repurposed tools and services might be responsive to distinct problems and challenges confronting the so-called Future of Aging. The Panel Participants were charged with identifying “passionate problems” in their own enterprise that are ripe for innovative solutions and offering them up to designers and entrepreneurs in the audience who might have an idea about how to accelerate a solution to market. Through the intersection of organizations like Aging 2.0, MeHI and Continuum Innovation, we now have a relatively captive audience for the most coveted resources of (1) designers that can create and/or reimagine tools, and (2) providers representing users that can test them.
The Reverse Pitches
The following presents “Passionate Problem” statements shared by each of the Provider panelists:
“We want to create an interactive dashboard to look at the whole person’s needs (financial, legal, housing, health) that they or we could tweak or update as their situation changes.”
“People with dementia often don’t have the ability to communicate their physical and emotional needs. What if there were a way to make family and professional caregivers aware of those needs as they were happening?”
“We need technology that will liberate our workforce from managing information and deliver real time wearable data on a resident’s preferences, conditions and care plans as soon as they enter the resident’s home.”
Where do we go from here?
While topics of discussion were diverse, two broad elements of commonality seemed to emerge to constitute a “theme” of the event – or at least the “takeaway” challenge. First, connectivity inasmuch as technology is breeding a smaller world with real time access to one another and critical information. Second, the growing need for personalization of technologies that can be customized to individual needs and preferences. In the realm of Aging Services, opportunities abound where connectivity coupled with personalization will breed valued technology solutions. Beyond healthcare providers, primary family caregivers require better information access to monitor the well-being and needs of their loved ones – and to guide their own sense of oversight and intervention. As Christoper Sintros noted in his remarks, “we need to learn how to better leverage technology so that our cargivers are 100% focused on caregiving.” He added parenthetically that “our frontline caregivers – our front-line staff – have not benefitted from technology.”
In spite of all the accelerator groups that have emerged and are multiplying – and the c-suites that proudly wave the banner of innovation – our collective efforts are still somehow off the mark. In order to truly Change Aging, we should focus on the simple things first. The future is already here as they say – it is just not evenly distributed! Of course, we are not suggesting that all of the solutions we are seeking exist already or that they are in a turn-key state. Rather, our insight is just that there are so many parrallel activities present that our key actionable attention should be laser-focused on (1) awareness of what has been done already and (2) the desire to connect with the right people. We are all standing on the shoulders of giant. It would be a critical mistep to move forward in in our care business with blinders on.
Here is one example lead…
Sentio Solutions has created Feel, the first wristband to monitor emotional wellness, track feelings and manage stress. The integrated wristband sensors measure and track biosignals throughout the day, including galvanic skin response, blood volume pulse and skin temperature, to show individuals how their mood is affected by factors such as activity, the people they meet and environmental conditions. Through Bluetooth enabled communication, the Feel app visualizes the results and provides personalized recommendations to improve emotional health. Co-founded by George Eleftheriou and Haris Tsirbas, Feel is helping individuals manage their emotional health and improve their overall well-being. For more information visit www.myfeel.co.
Lets try to connect people, products and organizations actively together
This is an unprecedented time in our history because we are now often able to use the metaphor of an existing tool to describe modest innovations that established organizations are seeking. For example, in Veronica Barner’s pitch she expanded upon her problem statement by describing how caregivers could benefit from a Fitbit or Apple Watch type of device adapted to monitor mood variations and detecting the onset of depression or other behavioral indicators. Does the feel wearable represent a possible outlet for this problem/opportunity? You never now what the outcome of a chance encounter might be. Why not leverage our collective knowledge to broker these interactions?
Undoubtedly there are people and products waiting for a connection…
Please share any ideas that you have in the form below. People, Products, SDKs – all shareable information has potential value. We will make sure you get connected and follow-up with you.
As technologies evolve, an emerging challenge is to source solutions that promote better aggregation of intelligence and eliminate redundancies of data collection and monitoring. Single source outlets are required that meet the customized needs and expectations of all constituents. Technologies need to be more fully integrated to provide real-time awareness of circumstances – providing timely detection of individual needs and preferences. Consequently, all constituents are aligned and informed such that healthcare providers and allied advocates present a seamless consortium of resources to foster the optimal support system for wellness and care.
Thanks to our Sponsors
We are proud to support and participate on the planning committee for the Local Boston Chapter of Aging 2.0. Events like these would not be possible without the support of our corporate sponsors. Thank you for your valued and recurring participation!
BOSTON – Local startups, Industry Professionals and Aging Services supporters converged last Thursday evening at the Boston office of Nixon Peabody. The focus of the event was to select winners from a series of 4 minute pitches that would go on to represent Boston in the 2017 Global Startup Search (GSS).
Capital Care Associates, LLC (CCA) was proud to be actively engaged in the planning and execution of the Boston Chapter Event while sourcing and securing event sponsors. Nearly twenty corporate sponsors representing a wide range of senior healthcare providers and service professionals participated in the program. “While emerging technologies prove disruptive to the future of aging, these new entrepreneurs amplify the opportunities represented by innovations surrounding person-centered care and quality outcomes.” cites Joe McCarron, Principal of CCA.
Allen Lynch, who hosted the event at his firm’s office, observed that, “the common denominator among the (participating) entrepreneurs was not just a passion for their product, but an often deeply personal reason for wanting to improve the lives of seniors.” Continued active support for the Boston Chapter from the existing professional and emerging entrepreneurial ecosystems prove that we are all invested in changing the way we age and how health care and wellness services are delivered in our homes and communities-at-large. Local events like these offer further proof that “Providers and ‘Enablers’ should come together in Senior Living.”
About GSS
The Aging2.0 Global Startup Search is an annual program designed to search the world for the best aging-focused startups. The competition kicks off with a series of pitch events in Chapter cities around the world – hundreds of startups apply to compete and local teams carefully select participants and judges for each event. The winning startup from each local pitch event moves forward to an online voting round, where the general public and panel of expert judges evaluate and contribute to the selection of finalists.
The final pitch event will take place during the Aging2.0 OPTIMIZE Conference in San Francisco November 14-15, 2017. This program is supported by Google for Entrepreneurs.
Local Chapter Updates
In his opening remarks, Tom Grape, Chairman and CEO of Benchmark Senior Living relayed to newcomers that the Boston Chapter is an arm of the global Aging2.0 organization, and that “our mission is to accelerate innovation to improve the lives of older adults here in Boston and around the world”.
Tom, who has served as the Ambassador of the Boston Chapter since it was established in 2015 introduced a new Chapter Ambassador, Tim Driver to attendees. Tim founded his company Mature Caregivers in 2006 with the aim of helping families to get better in-home care for their loved ones and to help people over 50 to find jobs that they love. It is a sister business to RetirementJobs.com, that administers the ‘Certified Age Friendly Employer‘ program, recognized by AARP and Consumer Reports, and the U.S. Senate Committee on Aging.
Seven Pitches representing Boston
In preparing for this year’s event, the volunteer planning committee was charged with vetting applicants. The following seven were chosen to represent the City of Boston and surrounding New England cities and towns:
LifeJourney Books – LifeJourney Books’ innovative and simple-to-navigate system rescues and preserves each Lifestory, an engaging and enjoyable process which strengthens generational bonds, and creates a Lasting Legacy.
Nebula Industries – Nebula Industries is solving the problem of medical adhesive related injuries for those with fragile skin, particularly older people, using innovative approaches developed at MIT/Brigham and Women’s Hospital.
Senter – Senter combines the latest IoT & AI technologies with a heavy focus on thoughtful user experience to make the home healthier and safer for aging individuals.
CareNav – CareNav is a digital health solution offering patient navigation services. Their scalable platform matches patients with experienced nurses for 1:1 virtual consultations, pre and post doctor’s visit, to empower and facilitate their healthcare experience.
BeON – BeON Home light bulb system senses the health and safety of your loved ones without compromising their dignity.
GreyMatters – GreyMatters is an interactive life storybook app for the tablet that aims to improve quality of life for people with dementia and their caregivers.
SilverBills – Using technology, we receive, scrutinize and ensure that our clients’ bills are paid accurately and on-time. Our clients no longer need to write checks or remember due dates.
The pitch event was emceed by Alice Bonner, Secretary of the Executive Office of Elder Affairs in the Commonwealth and the following industry experts served as the Judging panel:
SAN DIEGO – In Messaging New Directions we relayed the general theme for the NIC 2016 National conference – that cost, value and messaging need data, analysis and connections if a clear narrative is to emerge for Senior Living. As expected, there was a newly crafted narrative shared at this year’s NIC 2017 Spring Forum and it was informed by the confluence of data, analysis and some new connections. NIC engaged Anne Tumlinson to research the Board inspired thesis of creating value by intentionally coordinating bricks and mortar with emerging soft resources coined as “Enablers.” These findings became the framework for the NIC 2017 Spring Forum entitled “Unlocking New Value Through Senior Care Collaboration.”
Innovating Senior Care
The following NIC webinar provides a comprehensive introduction to many of the talking points that were expanded upon at the NIC Spring Conference:
Of note, Bob Kramer, CEO of NIC summarizes that, “Healthcare providers and payers are beginning to realize that if you are serious about delivering better health outcomes and controlling costs, housing as well as socialization matters, and in fact, without them you won’t achieve good outcomes.” There is a symbiotic opportunity represented by coupling asset-based providers with the care capabilities of so-called “enablers” and the captive customers they already represent – and can share strategically – in order to scale together. Kramer noted a remark from CEO of Kaiser, Bernard Tyson at the J.P. Morgan healthcare conference, that “40% of an individual’s health is driven by personal behaviors outside of the healthcare environment”. Recognizing the influence that non-real estate based providers of technology and services will have on the Senior Living sector is the first step toward breaking down silos of care.
Enabling by Example
Kelsey Mellard represented Honor at the event where they were the unofficial poster children for the disruptive (enabling) innovation our industry is being charged to embrace. Co-founder Sandy Jen’s brief TEDMED talk below captures their view on the impact non-medical caregiving can have on the cost and value of healthcare:
Jen describes how “unskilled home-care has always orbited outside of the traditional healthcare system of nurses doctors and hospitals and more and more, people are realizing that the home part of hospital to home is crucial.” She adds that it (home-care) can (1) reduce readmission rates, (2) increase quality of life for patients after discharge and (3) reduce the cost of provider health care to an aging population estimated to reach 84 million by 2050. In a recent Argentum post titled, “7 Innovations Changing the Aging Experience” Aging 2.0 Co-founder Stephen Johnston relayed that, “Emerging technologies have the potential to disrupt the senior healthcare market and thereby nudge service providers to improve their offerings.” If advice from NIC and their expert panels take root, it is likely that we will start to see a groundswell in active partnerships and collaborations.
The New World of Senior Care Collaboration
The Value Based Care (VBC) Revolution
The shift from volume to value in Post-Acute Care (PAC) is not going to be possible outside the broader framework that is mandating a transition from treatment of sickness to promotion of health. It is no longer sufficient to care for someone only when they are under your roof! When you recognize this, it becomes clear why an active focus on population health and wellness is critical. As tools and services that exist in the community become more sophisticated (and even ubiquitous) to consumers of all ages, it is imperative that senior living providers not fall behind. In the Forum’s opening session, leadership from Jupiter Communities, naviHEALTH and Optum relayed the following three key takeaways for success in seniors housing:
Provide evidence-based care and show strong outcomes
Educate both payers and traditional clinical providers that they (you) are a meaningful part of the solution
Collaborate rather than compete with other providers
Referring to the “right” PAC setting will be a critical strategy for VBC since “43% of Medicare patients utilize post-acute care after discharge and there is wide variation in costs across each setting.” As stated previously, 84 million people will be 65 years old or older in the United States alone by 2050. Beth Mace, NIC Chief Economist and Director of Outreach, contextualizes that datapoint further by reminding us that today’s 82 year old resident was born in 1934 and is part of the Silent Generation. With all of the age wave and silver tsunami buzz continuing over the past few years, we are still years shy of the crest that boomers will represent for providers of housing, care and tech-enabled services. Now is the time to begin preparing for that certain demographic future.
Tweeting advice to the Industry
Thursday’s luncheon featured a panel discussion with Senators Tom Daschle and Bill Frist, M.D.
As the clip above reflects, we need to engage in a more active national conversation about our social contracts and the role our government should play in health care. Interestingly, Sen Bill Frist made multiple passive references to the role quality food and nutrition has to play in improving health and reducing the cost of care. Did anyone else hear this? Or was it just wishful thinking on our part? If we want to prove that we believe in breaking down silos, we might consider a 2018 NIC Spring Forum focused on the economic development and health impacts of advancing and deploying local food systems!
Takeaway from a Taxi ride…
Providence offered a clear metaphor for reinforcing the value of collaboration in the experience of my brief taxi ride to the San Diego International Airport. As I stepped onto the Bayfront Hotel porte cochere, I could see that there was a single taxi waiting. The attendant escorted a woman into the back seat and then quickly turned to me and summoned the next car in line. Asking if I was headed to the airport, I confirmed that we both were. Our two, four-door, five passenger taxi sedans began to travel down Harbor Drive on parallel tracks together yet alone. We arrived at the same gate, at the same time, and we both presumably paid the same twenty-dollar fare.
The over-consumption model that this story captures mirrors many of our contemporary business relationships and transactions. In this example, some outreach and collaboration would have created immediate value for the two of us. Moreover, who knows what we might have discussed and explored through the connection of common interests. Do we really choose to consume alone or have we been artfully conditioned to relinquish our collective buying power? We should not consider ourselves to be victims of a broken system – we are active players that can influence the rules of the game.
Interestingly, our industry predicament seemingly proves a microcosm of our world at large. Our communities, industries and nations need to honor a simpler mandate – we must always demand and promote more collective EFFICIENCY every-where and for every-one. These are habits that must be formed and refined if they are to take up permanent residence in our collective psyche. If we identify and optimize what is wrong in these daily details, the broader canvas just might correct itself. There is a clear opportunity attendant to the messages that NIC and others are developing for us. The challenge is to expand the scope of our inquiry and recognize through our actions not just that silos represent lost opportunities for added value creation – but that all of our silos are nested one inside of the other. When we celebrate acceptance of an expanded and more inclusive perspective, we must remind ourselves that their is an ever-widening circle to be informed by. As in our own business practice, “Combining Capital with Care” seems like the formulary for success.
We recently attended The Erickson School’s 5th Annual Memory Care Summit in Orlando, Florida. The Coronado Springs Resort at Disney World proved to be a symbolic venue represented by engaged staff who reminded us in real-time what the ideal customer experience feels like. What better way to explore the facets of Memory Care – and its growing significance for an evolving Senior Living Industry – than with the timeless nature of a Disney “theatre” as backdrop.
SETTING THE STAGE
Best practices proffered by the Walt Disney Company about employee training and brand management almost felt unrealistic. The competitive advantage of being part of a “magical kingdom” seemingly anchors them in a winner’s circle far removed from our own care industry. In the days that followed, it became clear that this apparent advantage just MIGHT be attainable for all. Is it possible that success is as simple as telling stories with lessons that can be shared, recalled and channeled – to inform the moments we create with residents, staff and families? It is our ideal nature to care and to be cared for. If we don’t seize opportunities to create meaningful relationships that extend beyond routine tasks; we are losing more than just a bottom line.
CULTURE COUNTS
Employee Engagement is the key
The Program launched with a 90 minute presentation by Mark Matheis of the Disney Institute. Sponsored by Integrace and entitled “Disney’s Approach to Employee Engagement,” Mark portrayed Disney’s management excellence while sharing the underpinning of a customer service philosophy where everyone is special and everyone contributes.
Validated by his own 27 year career recall with Disney, his engaging stories exhibited the “real deal” that constitutes and carries the Disney culture. Like our own business, it’s the genuine caring for both employees and customers that fuels success. There is at lease one key attribute required of every Disney employee – you’ve got to be genuinely “nice” to join the team.
Green Side Up
Mark amplified one experience in the opening of Disney World’s Orlando Resort that captured the role storytelling can play in our education, training and engagement activities. Amidst the chaos surrounding opening day, it was the President of Disney who detected that a critical item had been overlooked. The Resort’s Grand Floridian Hotel did not have its grass sod laid – though it was neatly stacked on-site. He immediately dispatched a message to his entire team. All those not engaged in critical business were to report directly to the Floridian for priority assistance required. In the meantime, the President loosened his tie, rolled up his sleeves and began to unload and place squares of sod in front of the building. With beads of sweat emerging, a senior team member approached the President in response to his appeal. With some reservation, the executive, accompanied by others, expressed that he had never done this kind of work and questioned the skill-set required. The President offered a simple response, “It’s easy. Green Side Up.” And so it was that all joined in and the job was done. To this day, every employee knows the mantra of “Green Side Up”. It is a powerful metaphor that informs desired behavior. We work together toward the common goal of delivering a unique customer experience; irrespective of formal titles or job descriptions.
Overmanage for Sustained Results
Mark also relayed that “Disney’s consistent business results are driven by “overmanaging” certain things that most companies undermanage or ignore – and that is a key source of what differentiates us.” In simple terms, they “have learned to be intentional where others are unintentional.”
The example of an intentional act was captured by the deconstruction of a wave from a Disney Princess. The mechanical formulary of “wash the window, wash the window, missed a spot, missed a spot” captures the spirit of how designed experiences that have been broken up into meaningful elemental actions that can be easily shared and sustained as a desired behavior. It is not a huge leap for Animators to dissect micro-motions like this but that is the point of integrative thinking; to seek constantly to reframe problems and opportunities from alternative perspectives that capture every detail. If you do not create a script for your operation, how can you effectively train your team and deliver your brand’s promise?
TRANSFORMING PERSPECTIVES
Our second day began with a presentation from James Hendrix, the Director of Global Science Initiatives at the Alzheimer’s Association, where we were reminded of their three-pronged mission to eliminate the disease through (1) the advancement of research; (2) enhanced care support and (3) the reduction of risk for all dementia sufferers through the promotion of “brain health.”
What is the scope of the problem? 5.4 million Americans of ALL ages will have Alzheimer’s in 2016 at total cost of care of $236 Billion according to the CDC! Interestingly, in a supplemental peer-reviewed journal entry, we learned that “…the Association also believes there is sufficiently strong evidence, from a population-based perspective, to conclude: (1) regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) have been shown to reduce the risk of cognitive decline and may reduce the risk of dementia; and (2) a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive
decline.1”
What’s the take-away? In spite of the millions of dollars (and human hours) spent yearly, we are not any closer to a meaningful cure BUT we have evolved considerably on the care front through the medium of Culture Change and Person-Centered Care (PCC) language and practice. Perhaps more importantly, a groundswell of professionals actively recognize that the “job” of Memory Care is not to heal or repair the disease; because we can’t (yet). Rather, our role as caregivers and family members is to relate and under-stand behavior so that we can be more supportive of individual needs as they struggle to mitigate the threat of a changing connection to self.
Ann Wyatt, Manager of Palliative and Residential Care at CaringKind relays that “Behavior is communication: it is not the dementia that causes the behavior, it is the dementia which prevents the person from expressing the cause of their distress.”
This change of perspective is transformative. It is conventional to bundle disease with symptoms in a cause and effect fashion but when you separate the two you become empowered to make a difference. In viewing behavior as form of communication, you are invited to listen more contextually and establish communication based on validation and empathy. This relational strategy is summarized by Validation Therapy’s founder Naomi Feil’s in her TEDx Talk at Amsterdam Women:
BRINGING IT HOME
Without question, the most moving part of this year’s program was the concluding morning presentations of day three. This segment is quickly becoming a promised experience delivered by the Erickson School’s Memory Care Summit; to conclude the series with human narratives that highlight the critical nature of the work we are all doing. Here we witnessed highly personal stories of two individuals confronted with life altering memory care circumstances. These interview presentations were moderated by Dr. Peter Rabins who consistently echoed the truism that our professional credentials do not fully prepare any of us to process the weight of memory loss among our peers and loved ones.
First, “Wearing Two Hats: Providing Care at Home and at Work”. This was the story of Teresa Robinson, VP, Clinical Services of Sagepoint Senior Living. Teresa is a caregiver in her organization as well as a caregiver at home as her husband was diagnosed with young onset Alzheimer’s before the age of 50. Second, “I’m Still Carol”. Carol Poole was diagnosed with Mild Cognitive Impairment (MCI) in 2013 and probable Alzheimer’s disease in 2014 at age 65. Remarkably, these two individuals continue to give beyond their personal burdens – sharing their experiences in hopes that it will advance a cause and help others.
To relay these stories further would not do justice to the love, compassion and caring commitment they represent. Suffice to say, these stories were heart wrenching and inspirational
– proving that Emotional Magic can fuel both the purpose and passion for evolving communities of practice around Memory Care. It certainly did for us.
SHARE YOUR STORY
In reflecting upon the Program Experience, the Disney backdrop certainly has relevance to our business models for Memory Care. We too can deliver those magical moments through intentional best management practices that are informed by our own narrative and brand identity. To be successful, we must support and sustain our own business culture that delivers on our promise of Person Centered Care – recognizing that Memory Care is indeed about validation and empathy. Our employees need to be genuinely engaged in a unified and integrated fashion with intentional purpose of enriching lives in the moment. Similarly, our service environments need to deliver the atmosphere and amenities conducive to comfort and care. Above all, our leadership needs to exercise the integrative thinking attributes that ideally empower, align and motivate our collective efforts by sharing stories that bind our thoughts and actions.
Data standards and integrity are arguably the two most critical ingredients when you consider achievement at either the (individual) human or (collective) global scale. There is no causation absent data (information) and there is no consequent execution unless it has been purposefully structured and validated for sharing. Healthcare Reform promises innovation in care delivery by increasing the transparency of data and quality metrics but how can you improve on something that doesn’t ideally exist yet?
When the OIG released its report, The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated, they noted a 29% margin (overpayment) for therapy service reimbursement. Further, Skilled Nursing Facilities (SNFs) increasingly billed for the highest level of therapy even though key beneficiary characteristics remained largely the same. Achieving information access and coordination throughout the “Continuum of Care” requires a call to action for better interoperability and data management practices if we want to be successful in the future value based / bundled payment systems. Common standards for (1) assessment/documentation, (2) secure exchange of EHR/PHI and (3) compliance/accountability across the Continuum of Care (Hospital to Skilled Nursing & Rehab to Home) need to be pioneered further before they can be adopted and enhanced. The Electronic Health Record (EHR) is arguably at the root of this opportunity but all business information has relevancy.
Introducing The 4th Industrial Revolution
As thought leaders on the world stage prepare us for the Fourth Industrial Revolution and Web 3.0 (The Semantic Web), we are reminded of the inequity gap that exists between enterprise level organizations, technologists and the remaining 99% of data users. That it to say that if best practices in knowledge management trickled down to Healthcare delivery the marketplace could be transformed very quickly. We get a glimpse of the future of work and mobile health when we watch a TED Talk or purchase a personal device with updated features but when will mainstreet be touched by technology that addresses productivity and information sharing in a more meaningful way?
Senior Living – as a subordinated subset of established industry classification(s) represents a now distinct and emerging asset sector, yet uniquely representing a blend of real estate; healthcare services; and hospitality. Everyone chatters about technology, disruption and innovation but we fail to emphasize two clear imperatives;
Simple, shareable language makes everything technically possible.
Business challenges have frequently been met and overcome in adjacent spaces (as the YouTube clip above intimates) if we only had the eyes to see them.
We must look to other industries to inform data initiatives that drive and define our evolving identity and moonshots. Of all the data we amass, what is more relevant to quality and compliance than the MDS? And how does that documentation relate to an EHR or related Protected Health Information (PHI)?
Stepping out of the Sandbox
There are too many languages in the medical community and they often represent overlapping or redundant concepts. Consider this post’s leading sub-title that suggests how innovation is intrinsically connected to interdisciplinary thinking. For example, IF we operate in a SNF setting and have a Medical Director as part of our Quality Assurance and Performance Improvement (QAPI) Committee but don’t understand either (1) the correlation between Quality Measures on Nursing Home Compare and the corresponding fields on each Minimum Data Set submission, or (2) the relationship between those measures and the 254 quality measures that CMS identified for the PQRS in 2015 (mapping to the U.S. National Quality Standard (NQS) health care quality domains), THEN, it is clear in this one trite example that we really need to rely on each other’s knowledge if we are going to make this work. Is it possible that there is a future scenario on the horizon where a more connected and semantic web will learn how to navigate and connect these complexities for us? The question becomes, how much accountability should we have for understanding and correlating all of these terms and frameworks? Leading from behind is not the sustainable solution.
The Need for Interoperability Standards
You are likely consuming this blog entry on a mobile device that is connected to the Web. The internet works because it operates upon open standards that have been established by the World Wide Web Consortium (W3C). If you are a designer or developer, you understand that you cannot create anything successfully without employing these interoperability standards in your own work product. On the other hand, we business consumers remain steeped online and in conferences with little emphasis on the need for knowledge to transfer.
The following clip references a government commissioned the JASON report that identifies what we have been getting wrong in our industry and prescribes an approach for fixing it:
It is clear that brilliant people endeavor to solve our problems beneath the surface-level chatter of our practice and headlines. They need our insight if the solutions they develop are to be (1) fast-tracked and (2) widely distributed. Our more active and collective engagement and collaboration will help make this happen.
Next Steps?
The challenges we confront in our sector (and frankly the majority of business industries) are downstream of lacking interoperability standards; inadequate reporting capabilities; and too few safeguards to ensure data integrity. The commodity of business intelligence is the new currency
of sustainable business success.
The call to action is simple. We need to be alert to exhibiting trends and become better data managers. We offer the following recipe for ACTIONS:
A – ssess and appraise current information systems capabilities.
C – orrect conditions of inadequacy, inaccuracy and redundancy of data gathering.
T – ransition reporting capabilities to achieve full integration for all users.
I – nterpret data intelligence routinely to inform best practice management.
O – pen and share data with collaborative partners to promote new prospects.
N – urture systems reporting to foster data integrity and build business bridges.
S – eek outside resources to develop and maintain data integrity.
Providers in our sector who best capture, manage, share and act upon reliable business data will be the survivors and prosper. New standards like FHIR promise to transform the way we conduct business and deliver quality outcomes but they represent future solutions. Data integrity defines not only your business identity, but importantly, your performance history and ratings in the marketplace. The Five Star Rating system in the skilled nursing sector is a good example of how reported data defines a business brand. Take charge of this information flow; ensure its integrity; and manage it to your advantage now before it is too late. That constitutes leading from the front.
Need guidance with your ACTIONS? Contact us to learn how we can help.
The “Seniors Housing & Care” tagline has been seemingly subordinated in a move that exhibits how the industry is being redefined. Although it was not stated explicitly, the original NIC symbol conjured a capital/institutional sentiment with its currency-inspired graphic whereas the new combination mark reflects a sea change that recognizes how data and its interpretative analysis are paramount to the survival of products and services that are now defining a broader sector – one evolving from “need driven” housing & healthcare services for seniors and now extending to “market driven” wellness and lifestyle delivery – ultimately for everyone.
As business and financial advisors focused on supporting regional providers of the industry, we value the NIC Conferences as an opportunity to step away from the trenches and immerse ourselves in ideas and best practices that represent a “collective IQ”. While we foster new messaging for our industry identity, we are reminded that we are all experiencing dramatic and unprecedented change, ripe with opportunity for those alert to exhibiting trends and signals.
As the NIC tagline suggests, data is of little use absent analysis and connections. In his opening remarks, Former Utah Governor Mike Leavitt relays similarly that “information gathering and making sense of weak signals is critical to success.” In this post, we share takeaways from the opening session together with select NIC Talks featuring Ken Dychtwald, Billie Jean King and Joseph Coughlin. When you synthesize the talking points it becomes clear that cost, value and messaging need data, analysis and connections if a clear narrative is to emerge.
Strategic Aggregators
Mike Leavitt suggested in his opening remarks that the value-based payment system is one of the most significant changes confronting the US Healthcare system and its future remains uncertain. How can we drive the implementation of these changes more quickly and who will take center stage? Senior care providers can respond in three ways; (1) fight and die; (2) go along and have a chance; or (3) lead and prosper. More specifically, he offered that there is an open opportunity to become what he refers to as a “Strategic Aggregator” in our evolving coordinated network. In simple terms, this role could be understood as the “general contractor for medicine,” someone who is able to crack the code of a fee-for-value service world.
Connection, Purpose and Meaning
“Who are the boomers going to be when they get older? If you get that wrong, you’re out.”
As the Founder and CEO of Age Wave, Ken Dychtwald relays that messaging, marketing and communications provide the largest barrier to our industry and that we will likely be challenged to turn market sentiments around. In sharp contrast to the linear model of aging that we are accustomed to, there is a “longevity bonus” on the horizon and we will need to establish a new narrative for how to keep connection; purpose; and meaning at the center of our offerings. Ken proffers that “if you are building your communities, and your marketing and your intelligence is based on the 20th century notion that people will really want to stop work, separate from society and not do much of anything other than relax and socialize and be called seniors, you are going to fail. I don’t want you to fail.”
What can we do? We need to tell a better story that works to address the core issues of loneliness and peace of mind but emphasizes how we support a reinvention of life so that the prospect of new active aging possibilities are front and center. We need a new narrative that better communicates our offerings – displacing negativity and ignorance about the industry. We need to create on-ramps for reinvented offerings and exit-ramps from the “Fortresses for the Old”.
Relationships, Learning and Problem Solving
Billie Jean King framed her session with recognition that “Sports is a Microcosm of Society.” From an early age she had a purpose and a goal that intentionally leveraged her tennis career to champion social change. As the active aging ambassador for Atria, she shares her insight that inner and outer successes rely upon relationships, learning and problem solving. Atria doesn’t use the word “senior” any longer but Billie highlights the value she has always placed on older people – while admitting that she now feels the influence of ageist stereotypes personally.
Elders are a source of wisdom where we can better tap into and leverage the value of life experiences they offer. Stay active, keep learning and recognize that relationships are everything. Personalized engagement is key to promoting well-being and should be fostered through important opportunities for acts of kindness. “Active is happy.”
Excite and delight
We are reminded by Joseph Coughlin of MIT’s Agelab that it is the convergence of technology and the consumer that bring real innovation into the marketplace. He advises us to focus on what we are trying to accomplish first and then try to find technology that will help to accomplish those goals. Technology is the “tool box”. While musing about the impact of “aging in place” technology, he notes that a tech-enabled service that could keep you in your home for an extra six months could have a $34B impact on the industry.
The major takeaway? Senior providers have the expertise to hop over the fence and develop relationships with people in the community before they even need your services. Building a pipeline into the Home & Community service realm is critical but we must be reminded to “excite and delight” with our offerings. “Generation Expectation” believes that there is a “product, policy or pill that will enable them to live longer and better” and innovators that can answer the call will be well rewarded. New players will be branded by collaboration in a newly defined sharing economy. Life on demand through apps will continue to emerge with a focus on wants as well as needs. Having it all and owning none of it is the value proposition. Above all, you’ll need a good marketing team to get your messaging right.
Where do we go from here?
Recognize that your are missing out on 90% of the market and focus on strategies for minting new customers (and staff) while reinventing and effectively messaging. Don’t try to guess what the whole market wants/needs.
Cultivate your own identity and engage followers wherever they are.
Seize opportunities to augment and or integrate your current offerings with community programs and services that are beyond your walls and intergenerational.
Find ways to incorporate programs for active aging, longevity and wellness.
Promote opportunities for lifelong learning, engagement and problems solving through new relationships and technology that “excites and delights” all ages.
Get your messaging right and get it out there effectively.
Relationships, Learning and Problem Solving
Billie Jean King framed her session with recognition that “Sports is a Microcosm of Society.” From an early age she had a purpose and a goal that intentionally leveraged her tennis career to champion social change. As the active aging ambassador for Atria, she shares her insight that inner and outer successes rely upon relationships, learning and problem solving. Atria doesn’t use the word “senior” any longer but Billie highlights the value she has always placed on older people – while admitting that she now feels the influence of ageist stereotypes personally.
Elders are a source of wisdom where we can better tap into and leverage the value of life experiences they offer. Stay active, keep learning and recognize that relationships are everything. Personalized engagement is key to promoting well-being and should be fostered through important opportunities for acts of kindness. “Active is happy.”
Excite and delight
We are reminded by Joseph Coughlin of MIT’s Agelab that it is the convergence of technology and the consumer that bring real innovation into the marketplace. He advises us to focus on what we are trying to accomplish first and then try to find technology that will help to accomplish those goals. Technology is the “tool box”. While musing about the impact of “aging in place” technology, he notes that a tech-enabled service that could keep you in your home for an extra six months could have a $34B impact on the industry.
The major takeaway? Senior providers have the expertise to hop over the fence and develop relationships with people in the community before they even need your services. Building a pipeline into the Home & Community service realm is critical but we must be reminded to “excite and delight” with our offerings. “Generation Expectation” believes that there is a “product, policy or pill that will enable them to live longer and better” and innovators that can answer the call will be well rewarded. New players will be branded by collaboration in a newly defined sharing economy. Life on demand through apps will continue to emerge with a focus on wants as well as needs. Having it all and owning none of it is the value proposition. Above all, you’ll need a good marketing team to get your messaging right.
Where do we go from here?
Recognize that your are missing out on 90% of the market and focus on strategies for minting new customers (and staff) while reinventing and effectively messaging. Don’t try to guess what the whole market wants/needs.
Cultivate your own identity and engage followers wherever they are.
Seize opportunities to augment and or integrate your current offerings with community programs and services that are beyond your walls and intergenerational.
Find ways to incorporate programs for active aging, longevity and wellness.
Promote opportunities for lifelong learning, engagement and problems solving through new relationships and technology that “excites and delights” all ages.
Get your messaging right and get it out there effectively.
This is an important issue because we want to update you on a project that we have been working on for well over a year called Sectour. Issue # 003 will provide you with a quick introduction to the project and also showcase some recommended content (new and old) from CCA and around the web…
