Sometimes to really evaluate change you need perspective—and the broader and deeper the perspective, the better. It would be difficult to exceed the long-term care perspective of Maria Dwight, who has had 40 years of consulting experience with gerontological service organizations of every description, including nursing homes and assisted living firms. Her widely known consulting firm, Gerontological Services, Inc., is celebrating its 25th anniversary this year. She and her staff provide expert guidance on all aspects of senior-oriented operations—from feasibility and marketing studies, to project development, to operational guidance, to technology integration, to advocacy for the “computer-innocent” in planning their information technology (IT) systems. During her long career—most notably in recent years, she says—the long-term care and services market has changed so much that were she starting out today, she would adopt a career path more oriented toward direct provision of services. Recently she reviewed her impressions of these changes and what they mean to the field in a conversation with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.
Peck: What to you have been some of the more striking signs of change in the marketplace in recent years?
Maria Dwight: A good example is Sunrise Retirement Communities’ “Condos for Life,” which bring all sorts of service directly to a resident's condominium via a concierge service. The concierge may or may not be a MSW (master's of social work), but he or she does everything from changing the kitty litter to administering IVs—a range of services so that residents can age in place. Sunrise didn't go into this approach to home-based care out of the goodness of their hearts—they see it as good business.
Another model that fascinates me is the Beacon Hill Village in Boston. The program does not provide services directly to seniors living in their apartments, it acts as a broker for those services—screening them, contracting with them, and monitoring their performance with online satisfaction surveys. This approach makes a lot of business sense to me. From the service provider's standpoint, association with Beacon Hill is a community's sign of approval—and if the provider gets dumped, it risks losing significant market share. With this model there is more efficiency, less duplication of services, and more peace of mind. In exchange for knowing that someone providing services in their homes is prescreened, qualified, and bonded, people are willing to pay membership fees. This model is, to me, a cool idea, and if I were young and just starting out, being as entrepreneurial as I am, this is what I would do.
Peck: Some say that service operations like this are making urban revitalization to support senior environments a viable alternative. Do you agree?
Dwight: Yes I do. More and more I'm hearing people say this is what they want for their retirement years. They want walkability, they want ready access to stores and entertainment, they want educational resources and to be able to pursue lifelong interests. And they don't want to be isolated.
Poor schools were a factor in chasing people out of cities in the past, but for empty nesters this isn't a consideration. Of course, the neighborhood has to be safe, and transportation has to be good.
Peck: But isn't this a major obstacle to revitalization efforts these days—the lack of clean, safe, adequate transportation?
Dwight: That's true, although there have been some ingenious ideas for dealing with this. One is something called “zip cars,” which you see quite a bit of these days in San Francisco. This involves being able to rent a car by the hour, as needed, totally online, and not having to worry about all the responsibilities of owning a car.
Peck: One interesting demographic trend these days is people moving past suburbia into exurban areas, into what have been called “edge cities.” Do you think this demographic shift will figure into senior services trends?
Dwight: Right now I think pull is in the opposite direction, in the direction that we have been talking about. People who have spent their lives in the suburbs say they're conscious of having missed something. Their lives have revolved around their work and even their friendships are professional. People today are looking for community. As empty nesters, they want to know how to reconnect with society and follow their lifelong interests. That is why the motivations for someone moving into a senior community today are so much different from those of older generations, who were primarily seeking healthcare and physical support. I see this change as very positive.
Peck: What sort of opportunities do you see in all this for facility operators providing skilled care and assisted living?
Dwight: Well, nursing homes these days are very much in flux. I don't know if the Green House thing will pan out but certainly there will be a change of attitudes regarding senior care. Long-term care is moving strongly now to a residential model and to setting up or working with continuums that provide care and services across the board, including clinical care in the home. There are some interesting opportunities for joint ventures. For example, physical therapists are very hard to find these days so, if you have good physical therapists, why not share them with those providing home care? Why not use them in a way that the market is demanding today and, in that way, reach out to the community? That's good marketing.
Peck: What about another form of community outreach—the wellness center?