In our previous blog we described the $1 Trillion opportunity dangling in front of us. Hopefully you asked “how do we participate?” In our next three blogs, we describe: the care model, the partnerships, and the defined payments we think are fundamental to success.


Senior housing operators bifurcate what we provide: in the words of one NIC attendee CEO, “are we providing room service or are we providing skilled nursing?” We argue that it’s neither – rather, we have a duty to provide integrated services in the form of coordinated care for our residents.

We call this the Care Model of Seniors Housing 2.0. Let’s explore what it looks and feels like:

What the Care Model Feels like to a Resident and Adult Daughter

Imagine yourself as a resident today. Or her adult daughter. Let’s describe what happens today, in order to contrast it with the Care Model of Seniors Housing 2.0.

Today, when a resident feels pain or discomfort, she probably bears with it until it’s no longer bearable. We have all heard the stories of a resident who was constipated for six days. She finally faints and was rushed to the hospital’s ER department. Her daughter gets a frantic call while on a business trip.

The adult daughter rushes back to be with her mom, meanwhile fielding the ten or more phone calls coming in from her brothers, her aunts and uncles, and the assisted living facility about how long to hold the room for. The resident is discharged after a two day stay, and since her visit was logged “for observation,” her daughter will receive a mound of bills which she needs to dispute.

Meanwhile, the story doesn’t end after the hospital stay. The resident is at risk for dehydration because she is afraid to eat or drink lest she gets constipated again. Re-hospitalization looms on the horizon. Her daughter is on the phone for hours disputing the first of many bills she receives but her mind is on her next business trip…how to cancel without it affecting her work performance. Nobody is happy.

In our Care Model, this story unfolds in an entirely different way. Instead of waiting six days with constipation, the resident sees her nurse practitioner on her way to the dining room. On day three, the nurse practitioner gives her a treatment for constipation. The medical assistant (“concierge”) helps the resident get the medicine that day.

The issue is resolved. The adult daughter is never called – because nothing bad has happened. Instead, mother and daughter meet for brunch on Sunday as planned and enjoy spending time together.

It sounds deceptively easy, right? Yes. For the resident and family members, it should be easy.

How to Create the Care Model in Your Community

Here are the components needed in the Care Model of Seniors Housing 2.0:

  1. A primary care provider. We recommend a nurse practitioner.
  2. A care coordinator. We call her the “emcee” or “care concierge.”
  3. A community with nutritious meals, transportation, and social support.
  4. Ancillary service providers. We recommend therapists, pharmacy and possibly non-medical home care.
  5. An electronic communication platform that everybody described above uses. For each resident, this system provides a record of conditions and care over time. It allows real time communication and the same information play book.

Again, it sounds easy, doesn’t it? In a way, it is easy.

Why Has Our Industry Not Grabbed This Opportunity-and How Do We Change?

Many providers who read this will say they already are doing this.  Others will say that without the necessary IT already in place, it will be hard to justify economically. And still others will know that the culture that supports siloed care must be replaced and that changing that mindset is easier said than done.

But let’s focus on addressing and removing the financial obstacles.  Short term economics may cloud long term gains. If operators only see the additional hiring needed, then they may miss how the nurse practitioner is a Medicare reimbursed benefit. At the same time, while most traditional operators recognize that the most common reason for a resident move-out is due to medical reasons, it may be hard to see the longer-term gains of increased occupancy because fewer residents are discharged due to medical reasons.

Piecing together these five components can be hard. For example, dominant EMR systems, such as PointClickCare and MatrixCare, though great at doing some things, aren’t widely used by specialists, such as therapists. Instead, they rely on the robust therapy logs and billing systems that come with therapy-centric systems, such as RehabOptima. For this care model to work, everyone, including therapists, must use the same EMR. And we all know that interoperability continues to be a prayer rather than a reality.

For a long time, Erickson has had a similar Care Model at work inside the walls; but, the Erickson model of 1,500 units operating with mega economies of scale was too unlike the rest of seniors housing and care.

More recently, Juniper Communities has shown how this Care Model can work in a variety of seniors housing and care settings, from independent to assisted living and memory care. It helps that Juniper has consistently measured a several point increase in occupancy due to their Connect4Life Care Model.

And slowly, sentiments towards this Care Model are changing.

At this point, it’s more a matter of how (partnerships) and how to pay for it (defined benefits and payments).

Stay tuned: we explore these topics in our next two articles.