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CW 108: Jane Rohde

Reinvention! BTG Contributor Jane Rohde discusses the importance of embracing care coordination and value brand care.

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Let’s start looking at it from a multi-family, a mixed use perspective and actually embracing care coordination and value based care. Now’s the time to look at the community as a larger thing outside of the walls of what we are currently designing and building and operating.

 

Welcome to Bridge the Gap Contributor Wednesday. My name is Jane Rohde. I am the founder and principal of JSR Associates and also the founder and president of Live Together, an intergenerational community model organization that was developed as a nonprofit. It focuses on intergenerational living and care for elders in a different model. So today I was trying to decide what we should talk about, and I saw two articles this week that I thought, Hmm, I think we could connect some dots. So let’s connect some dots between a few things that I read and a few things that I was very surprised about. And one of the articles, it talked about assisted living models being broken, and that there we needed to disrupt ourselves. I thought, well, that’s very interesting. And what they were concerned about was the disruption of care coordination and value based care within the privatized assisted living market.

1:25

And to me, I was surprised that that was looked at and evaluated as a separate thing instead of person-centered care, always being the ultimate of what everything and all the decisions should be made upon is from a person-centered care perspective from both families, for staff, and for residents. So in looking at this, in terms of kind of upending normal business, the embracing of alternative models I think is essential, and we’ve seen care coordination working for decades in terms of the outcomes. The regulations and the reimbursements have not kept up with care coordination and the payment of that service. That’s the disappointment. Not for sure during Obamacare that we would’ve actually gotten care coordination, would’ve been something that was funded, which I think would’ve helped with not only value based care, but just the outcomes in general, because we know that services are one side and the senior or elder and the family is on the other side. And so much of that coordination and the in between does not get handled well or handled at all. 

So if someone’s being discharged from the hospital and there’s not a full sequence of what happens, what’s the home evaluation, how are they going to do when they get home? Do you have the care and service you need when you get home? And ultimately, do you have food available? Do you have someone to stay with you? All of those different components that happen through care coordination that need to occur to provide a healthier outcome and a more positive outcome for everybody involved. The other piece that I saw was a large multi-family developer was going pivot to senior living community development. And I thought to myself, wow, you’re already in large multifamily, you are in senior living. For me, if you were looking at multifamily, that also means you’re looking at intergenerational or multigenerational, at minimal, within that community.

3:20

If you added that care coordination to a multi-family building, that could not only positively impact older adults that are living there, but could also positively impact everyone who lives there. The single mom who has a child, and the child is sick that day. And before she goes to work, there’s definite issues. And what do you do? If you had a care coordinator or someone there? And we look at a lot of, Hmm, I’ll say sexier titles, things like concierge or a health and wellness or wellness concierge, someone who’s there who helps coordinate what you need. So it’s not only the care service specifically that you may need. It might be the means to get there addressing IDLs, but that’s IDLs for everyone. So if it’s a childcare issue, if it’s an adult care issue, if it’s a specialist issue, if it’s transportation, if it’s meals for a certain number of days, because you have an illness or you have something temporary like a hip replacement recovery, or a knee replacement recovery. That coordination of care that we talked about earlier, that seems to be a bit in the fearful bucket for the assisted living developer, was interesting to me because for me, a large multifamily can be easily transformed into something as an intergenerational model, simply by evaluating your property management staff.

4:45

So if you start looking at the staffing models and figuring out what’s going on there, we see that in buildings I’ve worked in, in the city of Baltimore. Often they would have a property manager and then an assistant property manager, who replaced that assisted property manager with a nurse or a social worker, or even an OT PT, or was able to do those three as the triad of care to do coordinated care, amazing things could happen within the building. We saw less hospitalizations or deaths. We saw all kinds of good outcomes that could come from that, at a relatively reasonable cost. So then if we started talking about large multifamily and started talking about colocation, for some reason, colocation of certain mixed use such as retail or restaurants, that’s common. We’ve seen that we understand that, that’s part of the multifamily of evaluation of a site, but what if you were looking at multifamily a little bit more broadly, thought about it from a health and wellness perspective? We see buildings that have fitness centers, and then they have someone who’s actually the fitness trainer that can be hired by those that live in the multifamily building.

5:58

So they’ve, they’ve made relationships and they’ve vetted those relationships for you as a tenant, but they allow you to have access to those services. So if we started looking at mixed use as why isn’t the home healthcare agency within those multifamily settings, why would we not have physical therapy and occupational therapy as a potential service that’s within that building? And whether that’s an outside operator that is paying rent within that space in a mixed use setting, or it is the operator themselves that provide those services that creates a continuum of care. It’s a different way of looking at it. You’re not looking at segregating, you’re looking at integrating. And so that inclusivity gives you a whole different view of how you can evaluate whether multifamily becomes senior living. And why have we dictated it as senior living instead of just living. You look at different people living together, it’s never been normal for any of us to be age segregated or segregated in any way.

And so when we start looking at that and the ageism that can be attached to that, think of the value to not only a younger child, or a family member, or a millennial, or anyone, and an older adult. If someone had a care need, and it was for a child, and an elder could provide that service. Why would you not want to identify that within your multi-family building, to support those that are living there? 

7:21 

So when we start looking at it, I just thought it was interesting that one wanted to pivot from multi-family to senior living. When the reality is, they could easily become senior living if you use the senior term. But basically you would be looking at the co-location of different services. Every community area is different. What we’ve learned from the Live Together model is that it’s not the same pieces that you need for one community to another. 

One community may need home healthcare. Another team may already have it. Another township may have what they need, but the rural community may not be served. So how can that be used as the base, and then the rural community around it could assist that and support that? 

So when you start looking at things on a broader scale and more specific to the grassroots of the needs that are in a local area, you give a much better idea of how and what mixed use and multifamily can mean because then you’re creating community. And that community is not dubbed senior or young, or I don’t know any other term you want to use for creating ageism and segregation and separation of people by ages. So what if we just looked at it as living and figured out what the community needed to support all ages?

8:41

So often I think we think that people who need certain service are only in the older market, but that’s not really true. If we look at people who might need a specialist, they may need physical therapy, they may need just access to transportation. That could be anybody, at any age, with any family condition. It may be temporary, and sometimes it’s permanent, depending on what the population is looking like. So, I really think that there’s a huge opportunity for us. That if you wanna really talk about disruption, which I thought was interesting, cuz that was something that was used in one of the articles that I’d read. Upending, normal business would mean embracing other types and ways to do the business. 

So if you were gonna take assisted living, and you were going to scale it down to a more residential level, and you were going to have folks that were living embedded in residential communities, whether it was a multi-family building or it was perhaps in a village, or in a township, or even in a development that was a little bit more suburban. But if you were looking at that as embedding it into the community, and they all used the same clubhouse, or they all use the same, we call them engagement centers for live together. But if everyone was able to use the same amenities and start to look at this, but not be age restricted, you can start to see how communities can develop again. 

10:03

Our communities were never meant to be designed so that they separate people. And so the opportunity to bring all those together is something we could truly do. That would be a positive disruption. I think sometimes we think the word disrupt means negative, but disruption can be good. Changing of mindsets can be really good. We can upend our industry because our industry really sorely, sorely needs change. And when we look at the senior living marketplace overall, there’s so much opportunity. So whether it’s mid-market, and if you think about multifamily, and you think about multifamily being at a median price point, and then you think about what are the multi tasks and multi type of housing amenities, I guess I would call them, or services. If you could couple those together within the multi-family world, and making the mixed use work, then you will be opening it to the whole community. 

So the whole community at large would have access to those services, whether it’s a cafe, or it’s a restaurant, or it’s the physical therapy, or the fitness center, or whatever is missing in the community at large. You make that available to all the residents that live there. Therefore you can support the various amenities, which you can also make the services not so broad brush, that they have to include everyone, so everyone has to do the same service. That’s very expensive. If we can back that out to provide the service more on an individualized basis, the irony of that is it can be much less expensive, because you’re opening it to a larger group of people. And so I think that is one of the problems too, is that it’s not only isolation and the opportunity for socialization, but it’s also this idea that we specialized to the point where more people cannot use or access to the service and amenities. We can allow more people to do that, then we spread the costs across that. And then the amenities are available to those who need them, at a more mid-market point or price point. 

12:08

So as we look at it, I guess what I would express and ask, all of you to think about is go ahead and disrupt. Be creative, not only pivot the model, blow it up, look at it, evaluate it, pull it apart. We have to do this now because even my more optimistic colleagues, who run amazing communities, who are amazing innovators, we’ve had conversations about the nursing home industry and the outcomes are not good. With the extra penalties that are being put in place, with the extra requirements that are required, but no additional money from the reimbursement side and CMS, but let’s punish and not reward. The problem with that is that we cannot survive in the market that was already so damaged in having trouble.

So now in trying to achieve that, and make it better, where are those older people going to go for service? So we have to look at different models. We have to look at a potential international or intergenerational, sorry. Internationally we are doing it, but intergenerational models. Because if we can really think through this, we’ve seen different community models work very well in the international stage. So can we couple with that, some of the lessons learned and start thinking through how would we care for people if we didn’t have a nursing home? Or we didn’t have our standard larger assisted living? What would it look like? What could we do? How could we reinvent? So it’s not really a disruption, then it’s a reinvention. And I think if we can focus on the interventions and the opportunity for innovation. Time’s, now we really need to do this now.

And it’s not only for our loved ones, but it’s also for the families, as many of us have been experiencing. And it’s also for ourselves, and our children. So let’s start looking at it from a multifamily, a mixed use perspective, and actually embracing care coordination and value based care because that’s what we need to do. And if we couple that with supporting our staff and workforce development and recreating, what is it like to work in our marketplace? And can we create a pathway for people to be trained, adequately trained, paid well, find out what the services are that the staff need, whether it’s housing or it is childcare. Fulfilling some of those needs, in that mixed use opportunity, gives you an opportunity to co-locate services that everybody can use. So, I think that now’s the time to look at the community as a larger thing outside of the walls of what we are currently designing and building and operating. 

Connect with me at BTGvoice.com, and thanks for your support and listening because we can only do this as a team collaboratively and cooperatively. So thank you very much. I hope you have a wonderful day and a wonderful week.

 

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CW 108: Jane Rohde