Page 30 —
COLORADO REAL ESTATE JOURNAL
— October 21-November 3, 2015
Senior Housing & Care
I
nAugust 2014, mymomleft
Denver to travel back to our
hometown in northwest Illi-
nois. My grandfather had suffered
from several ministrokes and falls
over the last couple of years, and
that spring he had been diagnosed
with pancreatic cancer. I had
already visited him in June, when
hospice had been brought in so he
could stay in his home. Just before
Labor Day weekend, he died in
the early morning hours with my
grandmother asleep in the lounge
chair next to his bed. He was 86,
and she was 82. They had been
married for over 50 years.
My grandfather died in the liv-
ing room of the rural one-room
school he and my grandmother
had added onto andmade a home
in the early 1960s. Although his
health had deteriorated, hers
was quite good. She didn’t have
problems with falls, her vitals
and vision were good, she could
walk well and her balance was
strong. Despite her positive state
of health, I expected our family
would have an easy time discuss-
ing options to move her into one
of the two assisted-living commu-
nities in town. Why wouldn’t she
move? Without my grandfather,
I knew she would become iso-
lated. Caring for him had been
her sense of purpose, and now he
was gone. She didn’t feel comfort-
able driving anymore, so she was
reliant on others for transporta-
tion to the grocery store, doctor
and church. If she would move
to a community, she would have
others around her for companion-
ship. She wouldn’t have to clean
or cook for herself, and there were
transportation options – beyond
the fact that she would be more
connected by being in town. Our
family’s concern about timing of
emergency responders including
paramedics and the fire depart-
ment would disappear. It seemed
very simple tome. It alsowas very
simple to her: She wasn’t leaving.
Aging in place is a hot button
discussion today. It’s commonly
recognized that by the year 2030,
20 percent of the American popu-
lation will be over age 65. AARP
estimates that “87percent of adults
age 65-plus want to stay in their
current home or community as
they age, and among people age
50 to 64, 71 percent of people want
to age in place.” The idea of aging
in place is not going away, but
what is the best place for aging?
The Centers for Disease Control
and Prevention defines aging in
place as “the ability to live in one's
own home and community safely,
independently and comfortably,
regardless of age, income or ability
level.” This concept is commonly
related to a person aging in their
single-family home. It can how-
ever, apply to a congregate com-
munity. A resident living in inde-
pendent living or an age-restricted
community may reach a point
where more care is warranted, but
the resident doesn’t want to leave.
Both options have benefits and
challenges.
For my family, aging in place
meant my grandmother wanted
to stay in her single-family home.
The problem with her home is
that it’s isolated in a rural area
and she doesn’t drive. There are
providers who offer in-home ser-
vices for seniors aging in place.
Amanda Cavaleri, thought leader
with CarnegieMellonUniversity's
Quality of Life Technology Center
and CEO of Connect the Ages,
has found that the biggest con-
cerns with elders aging in place
is combatting isolation and bore-
dom. “Fostering a sense of pur-
pose and connection to the outside
world are key.” Calvaleri previ-
ously operated a home concierge
service, enabling clients to thrive
in their homes. Home services can
allowseniors tostay in theirhomes
by providing them with social
interaction, care management and
coordination of care and out-of-
home services like transportation
to medical appointments or vis-
iting friends.
The clients are
often taken
out to perform
their weekly
errands such
as
grocery
shopping and
picking
up
medications,
instead of hav-
ing it done for
them. Living
independently
can become a
sense of pur-
pose of its
own.
Challenges do come with aging
in a single -familyhome.Although
the goal is independence, the
downside to in-home services is
that they typically do not occur
every day and cannot be lengthy
enough to provide enough social
interaction on their own. The cost
of the services can be impacted by
the “windshield time” service pro-
viders spend getting from one cli-
ent to the next. Another challenge
of aging in a single-family home
comes from spaces that are costly
or not easily adapted to barrier-
freedesign.Manybathroomswere
not designedwith clear floor space
or room for grab bars. Retrofits
are possible using accessories like
swing-down grab bars, but often
feel forced. The necessary use of
stairs in some homes becomes a
hazard by increasing the possibil-
ity for falls. These all become chal-
lenges when one decides to age in
place in their single-family home.
Daily services and other resi-
dents are examples of how con-
gregate communities have an
advantage. Living in a community
can easily facilitate socialization
on a daily basis. Even the most
cost-effective, age-restricted, non-
congregate communities can be
thoughtfully designed to integrate
spaces throughout that allow for
interaction. Congregate communi-
ties typically offer programming
to provide activities and learning
opportunities for their residents to
foster a sense of purpose and con-
nection. Communities typically
provide transportation that allows
residentstohandletheirownshop-
ping andmedical appointments. It
is easier and more cost-effective
for outside service providers to
serve a community because of the
density of residents.
Communities can provide a
strongabilitytofostersocialization,
but not all communities allow one
to age in the same place. The intent
of a CCRC is to move residents
through the continuum of care as
their needs increase, but the mov-
ing is not always well received.
Often when residents move from
their single-family home to a com-
munity, it is a significant transition
in their lives, andmany only want
to make that one last move. If the
resident moves into independent
living, it may feel traumatic when
they reach the point where they
need to move into assisted living
or a higher level of acuity. Another
challenge occurs when couples
age at different rates and one of
them begins to require a higher
level of care. The spouse likelywill
take on this extra care, but that is
usually a temporary solution. The
couple may be required to move
together, or themore rapidly aging
spouse may be required to move
alone.
In our project work, we find
that when designing a place for
long-term aging, many factors
should be considered. In a single-
family residence, easy access with-
out stairs is much safer to prevent
falls. Stairs should be eliminated
within the home. Bathrooms and
kitchens should be provided with
extra space so movement by a
person in a wheelchair – and
with assistance if necessary – is
possible. Ease of exterior mainte-
nance, or covering that through a
homeowners’ association, should
be considered. Flooring materials
should be easily cleanable. Inter-
nal lighting should be appropriate
for the color of aging skin and
sensitivity of aging eyes. In a com-
munity, spaces should be created
and placed throughout for gath-
ering and socialization. Facilities
can consider licensing to a more
stringent certification so it’s pos-
sible to keep residents in their
units longer, and a spouse if that
need arises. Noncongregate com-
munities also can seek medical
and other out-of-home services
that can serve the community
as a whole. Transportation and
connection to other neighbor-
hood amenities must be readily
accessible. Attention to the subtle
details of aging can create an
environment that sustains aging
in place.
Even though my grandmother
manages in her home today, it
is uncertain how long that can
continue or how long it should
continue. The reality is that aging
in place becomes challenging
as aging changes the human
body. Many single-family homes
do not easily adapt to reduced
mobility and can potentially cre-
ate isolation as they grant inde-
pendence. Communities can
help to combat many of these
challenges, but must continue to
evolve to support the changing
desires of different generations.
The communities that served the
silent generation will not likely
suffice for boomers. It will be
necessary for designers, develop-
ers and operators to challenge
themselves to push innovation
to meet the changing demands
of new generations while allow-
ing residents to remain in place
as long as possible. Housing that
safely accommodates the needs
of the aging body, that allows for
connection to others and the out-
side world and that offers the abil-
ity for one to maintain a sense of
purpose and independence. That
is the best place for aging.
s
Jami S.
Mohlenkamp
Associate principal,
OZ Architecture,
Denver
W
ith 10,000 baby
boomers turning 65
each day, senior-liv-
ing development is busier than
ever. In addition to experienced
senior-living providers adding to
their portfolios, brand-new devel-
opers are entering the market.
“We’ve been seeing a definite
trend in developers who are expe-
rienced in areas other than senior
living,” stated Elisabeth Borden,
principal of Colorado-based The
Highland Group, which conducts
market research and demand
analysis in the industry. “It may
be a landowner seeking a new
opportunity for a vacant piece of
property or a real estate developer
who is looking to diversity his or
her offerings in the market.”
This sentiment is echoed by
Camille Thompson, president of
CLS, a national senior- livingman-
agement and consulting company,
which has roots here in Denver.
“We get calls weekly from folks
who are highly experienced in
developing retail, office and mul-
tifamily housing,” said Thomp-
son. “They’re interested in getting
into the senior-living market but
wisely recognize that they need
experience behind them to pull it
off successfully.”
Organizations like CLS offer
specialized design consulting and
financial projections up to ongoing
management of the community
once it is completed.
“The design of the community
is essential to future occupancy
success,” according to Thompson.
“Fresh and innovative community
spaces, functional and appealing
apartment design, and the pur-
poseful infusion of technology are
key.”
In addition, Thompson advises
developers to remember that they
must design spaces that appeal
not only to the future resident, but
also to their adult children, who
often play an important role in the
decision making process.
While the design and construc-
tion process is important, the real
work begins once the building
opens its doors. What organiza-
tions like CLS do, noted Thomp-
son, is use their experience to turn
a building into a community. This
process has its own unique chal-
lenges.
Senior living is quite complex
compared to the operations of
other types of developments.
Operators not onlymust be skilled
in property management, health
care and the needs of older adults
but must also
have experi-
ence in offer-
inghospitality-
based services
like dining,
housekeeping
and concierge
services.
Hospitality-
based services
are definitely
becoming a
strong focus in
senior living.
At the recent Ziegler conference,
which focuses on cutting-edge
finance and strategic positioning
trends affecting senior-living pro-
viders, the need for hospitality-
based services was a common
theme. And, indeed, many senior-
living developers and providers
are taking their cues from the hos-
pitality profession.
Walk into a new senior-living
community and you may think
you’ve entered an upscale hotel.
Beautiful lobbies welcome you, a
concierge is present to help you
with anything you need, and a
few steps away, you’ll find hospi-
tality-based upscale dining.
But there’s more to senior living
than hospitality.
“At first blush, living in a
hotel sounds wonderful,” said
Thompson. “But because hotels
are focused on services, not rela-
tionships, living in a hotel for the
long term would be a very lonely
life.” Successful senior-living com-
munities have a mix of excellent
hospitality-based amenities and
services, and a warm culture of
community and relationships.
In addition to ensuring that
the culture supports resident-to-
resident relationships and friend-
ships, more communities are pur-
posely designing common spaces
that will welcome residents and
staff to come together as well. In
such an environment, residents
and team members often dine
together, exercise together and
participate in programs together.
According to Thompson, “This is
something you’d never see in a
hotel, but it’s critical to creating a
true community.”
Senior-living operators also
walk a fine line in ensuring that
hospitality-based services don’t
disempower residents. Moriah
Bernhardt, director of community
life at Clermont Park Retirement
Community in Denver, explained
that older adults often feel that
they no longer bring value to the
world. “Many folks feel that their
growth has halted and they’ve
developed a lot of learned help-
lessness,” said Bernhardt. “To
counteract that, customer service
must have a different approach.
Instead of saying, ‘I’ll do this for
you,’ we empower residents to do
for themselves and each other and
we are there to provide support.”
Focusing on empowerment
spurs residents to take a more
active role in their community.
For example, at Clermont Park, a
neighborhood of Christian Living
Communities, residents started
their own college where residents
plan, teach and attend classes and
work together with students from
the University of Denver to con-
tinue growing and learning. “Ifwe
focusedonlyondoing for people,”
saidBernhardt, “ClermontCollege
never would have come about.”
While a beautiful, well-designed
building is the foundation of a
successful senior-living commu-
nity, the creation of a culture of
true community, hospitality and
empowerment iswhat creates last-
ing success. By working togeth-
er, new senior-living developers
and seasoned operators can cre-
ate communities that people will
want to call home.
s
Jill Vitale-Aussem
Vice president of
operations, CLS,
Greenwood Village
