Colorado Real Estate Journal - July 1, 2015
Independent and assisted living communities are caring for residents with more complex health care needs than just a few years ago. Implementing protocols to manage these higher-care needs can help lower the community’s liability risk and increase its capacity to retain residents. Statistics from the 2010 National Survey of Residential Care Facilities through the Department of Health and Human Services revealed that 50 percent of the assisted living residents have three or more chronic conditions, and 42 percent of them have Alzheimer’s disease or other forms of dementia. Today’s senior-living providers must evaluate their caregiving capabilities and develop protocols and design features for those residents with more chronic health care conditions. Safety features such as wanderguard systems to prevent unsafe elopement, and cameras or pendants to assist in monitoring residents at risk of falling are now becoming more important features. With decreased mobility and increases in wheelchair, scooter and walker usage, having adequate space for storage and assisted mobility is key to a functional design. Offering robust wellness, rehabilitation, nutritional, nursing and clinical support programs is a great programmatic feature to help keep people active and engaged in preventative health efforts. There is a great opportunity to partner with post-acute, acute care and physician partners to develop specialized programs for top chronic disease areas that can impact resident transitional needs, such as developing a diabetic education and support group, offering a cardiac rehabilitation exercise class or providing weight management programs.
It makes sense that people want to avoid the traditional nursing home and, in fact, the original concept of assisted living was not to be a steppingstone to the nursing home but to take its place. Meeting these increased needs requires a combination of proper design, a new view of operations as well as a cultural shift within the community. Design should include the features that will allow people to remain as independent as possible. Wider door frames, raised toilet seats, grab bars and minimal flooring transitions are all key, even in residential living, where features like backing in walls to support grab bars should be included to meet future needs. Programming and operations must shift as well. And it’s not just about increasing staffing levels. Incorporating technology, sciencebased programming for successful aging, therapy and systems to manage chronic disease are imperative. Even with all of these structural and operational changes, however, we will not be able to successfully meet the needs of higher-acuity residents co-existing with more “well” residents unless we focus on creating cultures of inclusivity which people are honored and respected no matter what physical or cognitive challenges they are living with. In our current community cultures, people with higher-care needs often are shunned by their neighbors. This ostracism has a devastating effect on not only a person’s emotional well-being but also their physical health, leading to a devastating downward spiral and higher care needs.
Although current data supports the idea that both independent living and assisted living settings will continue to experience rising levels of acuity, I believe it will be important not to let this trend blur the line between these potentially very different property styles. Designing and building IL apartments that will support the transition to assisted living acuity levels may appear to be a smart business decision with the potential for slowing move-outs by those who have higher needs. However, many of the active generation beginning to arrive on our doorstep do not accept that assisted living needs will have an effect on their lifestyle and will not even accept the visual image of simple grab bars in apartments. These prospective independent living residents desire a residence that does not reflect or alert them to their future needs. A consciousness in both private space and common space design features that promote the independence factor, even if only an emotional subconscious thought, will be rewarded. Assisted living community design will be even more challenging as the reality of physical needs trumping lifestyle desires is experienced by very discriminating former independent living residents. The history of providing assisted living residents with similar private and common space design features in a smaller footprint may prove to be the standard no one wants to admit works best. The key to finding a way to meet rising acuity needs without diminishing the perception of independence may lie in the subtlety of space reinvention, not original design.
As seniors’ needs progress in senior living communities, and the overall care levels increase, an important component to our business is to implement innovative programs to meet these growing needs. The use of technology can play an integral role in preventative care management and engagement of seniors, families and team members alike. The senior living industry overall is beginning to understand the importance of the use of technology to encourage independence for our seniors. Companies that embrace technology, while still providing person-directed care, are becoming true leaders in the industry. From systems that alert staff when unusual behaviors occur, to more customized wireless caregiver alert systems, the goal is truly to prevent adverse situations from happening. Additionally, understanding how wireless radio-frequency identification door entry systems can maximize safety, and using exercise equipment created for seniors can provide motivation to improve levels of functional and physical independence with having metrics to support the improvement. Systems such as motion sensors within seniors’ suites, to help prevent falls, provide a level of security for both the senior and family member. The use of Skype, social media and tablet computers for residents to stay in touch with loved ones is an integral part of programming today, even for those residents with highcare needs. Overall, understanding how technology can improve the quality of life for our seniors without losing the human touch is a goal every senior housing provider should be focused on achieving.