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 Ten Years from Senior Aging Apex, What to Watch For

Skilled nursing alternatives such as assisted living, independent living, and memory care communities can only address a portion of the growing population.

 

The year 2029 will mark the last of the baby boomers turning 65, and by 2035, for the first time in U.S. history, the elderly population will outnumber children, according to the U.S. Census Bureau.

With the growing elder population comes new stressors to communities and caregivers. Currently 65 percent of seniors get their long term care needs from family and friends, according to the Institute on Aging. With the expected doubling of the senior population in the next 10 years, caring from family and friends will not be sustainable.

A recent study from the Institute of Medicine highlights growing crises in cases of dementia, substance abuse, and mental illness such as depression among America’s older adult population, which will require professional alternatives to address. The COVID-19 pandemic is only accelerating comprehensive change and crisis in the industry.

To meet the long term care needs of the baby boomers, social and public policy changes must be enacted soon. Alternatives such as assisted living, independent living, and memory care communities can only address a portion of the growing population. Skilled nursing centers, retirement homes, and home health care will have to adjust to new regulations and payment mechanisms. With these challenges come opportunities for entrepreneurs and operators.

Competition for this population will be fierce as there will be an increased focus on marketing the hospitality and amenities of facilities versus the type of care they now provide. Here are several predictions that may begin to move toward fulfillment in 2020 and beyond in preparation for the future of the senior living industry.

■ More care will be provided.
Senior living communities will expand health and welfare services to ensure they keep their residents in place, in lieu of sending them to a multitude of costly health care providers and other organizations. There will be a greater appetite to insource things such as therapy-based services, nutritional and social counseling, and diagnostic services as a source of revenue, compared with contracting them out.

■ Opportunities will exist for lower-cost, higher-quality communities.
Currently there are few low-cost providers, as assisted living communities typically cater to individuals with disposable income. That has to change. The elderly population boom will require operators to cater to a different socioeconomic class of seniors in need of care.

Regulations and payment mechanisms such as Medicare and Medicaid will challenge the government on how to balance the additional resources compared with the cost required in the future. Innovative solutions with an emphasis on communal living that provides synergies and cost efficiencies will become more common, allowing seniors to be part of a vibrant senior community.

■ Home care may become a more common solution to aging in place.
With the conversion to Patient-Driven Groupings Model (PDGM) in January that will change reimbursement for home health, providers will be reimbursed for remote patient monitoring, which will allow more seniors to age in place at home with the use of wearable health-tracking devices that will alert home care providers of changes in seniors’ health status before adverse events happen. Providers will have the opportunity to be reimbursed for the totality of the patient’s unique characteristics, compared with the number of therapy-based visits as in the past.

■ Labor will be a big issue.
With many states and companies such as McDonald’s, Target, and Amazon raising the minimum wage to $15 per hour, compared with $11 per hour for home health and personal care aides, the competition for employees has put a strain on senior living operators to recruit and retain employees. This coupled with the U.S. Bureau of Labor Statistics’ expected growth rate for home health workers of 36 percent from 2018 to 2028 translates into a need for 7.8 million new jobs. Recruitment and retention will be pivotal for the success of operators in the future—and to that end, as COVID-19 shifts the economy, will there be new recruitment opportunities for the industry?

■ Existing facilities will need to adapt to an older population.
There will likely be an increase in bed conversions or bed additions in senior living and continuing care retirement communities to accommodate expected increases in age-related chronic conditions or diseases. Currently, one in four people over the age of 80 is affected with dementia, according to Alzheimers.org, including Alzheimer’s disease, which should lead to expansion in memory care units in the senior communities. Dementia is one of the most expensive and time-consuming health conditions to care for in the United States.

According to Johns Hopkins Medicine, 70 percent of older adults with dementia live outside of skilled nursing facilities and are cared for by family and friends, which will change with the increase in the over-80 population.

■ Consolidation is coming.
Senior living is already flush with a variety of capital sources, new operators, and other entrants looking to cash in on the sector’s favorable demographic trends. As new players continue to enter the space, they are inevitably priming themselves and the industry for even more consolidation over the next few years. Smaller operators may be motivated to sell their properties as their labor costs and expenses in general increase, thus hampering their ability to grow the scale of their businesses. Therein lies an opportunity for larger providers.

Operators’ quest for liquidity as it applies to scaling their businesses will also play a significant role in further industry consolidation, suggests Ed Kenny, chairman and chief executive officer of Des Moines, Iowa-based Life Care Services. This certainly will be amplified and put on the fast track in the aftermath of COVID-19.

■ Technology infusion.
Most industries have been through a technology disruption in the past 10 years; what’s ahead for senior care? There is already an influx of new technology: Early detection systems for dementia, for example, and technology for security and safety (such as fall precautions and alerts) could lower costs and risk. Virtual robotic assistants may help with daily activities. Expanded and new phone apps can help handle reminders and alerts for medications and health screenings, and GPS systems and devices can help locate seniors if they wander.

Don Bivacca serves as a managing director at Healthcare Management Partners, a leading turnaround and consulting firm in the health care industry. With more than 30 years of experience driving successful operations of health care organizations, Bivacca also leads HMP Senior Solutions, a subsidiary of Healthcare Management Partners that specializes in operating senior care facilities and helping them manage new and expected industry challenges. He may be reached at dbivacca@hcmpllc.com or 615-601-2109.
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