Searching for Answers to Questions about Continuing Care: Point/Counter Point

Scott E. Townsley, a very bright attorney, an adjunct associate professor at UMBC’s Erickson School of Aging Studies, and a principal with CliftonLawsonAllen LLP, invited me to join him recently for a presentation to the 2015 Mid-Atlantic Region Resident Council Conference in Silver Spring, Md. (The lovely D.C. area cherry trees were in full bloom that day.)

Our theme was “Hot Topics in Continuing Care.”  Scott, a regular consultant to nonprofit CCRCs, used his deep experience in senior housing to outline his perspective on the biggest issues facing CCRCs. In preparation for my part, I reached out to my contacts in resident groups around the country and asked them to share with me their biggest concerns. 

We then trimmed down our two respective lists and used a Point/Counter Point approach to the debate.  Do any of our readers remember 60 Minutes’ James Kirkpatrick and Shana Alexander?  (Okay, how about Dan Aykroyd and Jane Curtin’s lampoon of the Point/ Counter Point format?  I think it is fair to say that we were less political than the first combo, and more polite — if less humorous — than the SNL crew.  But we had fun.)

With a tip of the hat to David Letterman in borrowing his “top ten” format, here is a very distilled version of my list of Resident Concerns:

10. What does it really mean to be a nonprofit CCRC in 2015?

9.  Do we need to worry about conversions of nonprofit CCRCs to for-profit?

8.  What is the right response to the trend that residents are older and more disabled, even when first entering the community?

7.  Conversely, what about concern there could be discrimination against those who need more care but want to stay in independent living?

6. Are there ways to reduce delays in promised refunds of admission fees?

5. Does a recent history of bankruptcies indicate a deeper problem?

4. There is still a need for a “Bill of Resident Rights.”

3. When residents voice concerns is that necessarily antithetical to marketing?

2. Management/Boards should share more information with residents about finances, including debt and any debt refinancing, and should strive to make the information understandable (rather than opaque).

1.  Paternalistic attitudes of management towards residents is demeaning (“don’t pat our greying hair and tell us not to worry”).

Scott’s list of top issues, from the perspective of governing and managing bodies of Continuing Care Communities, was shorter but compelling:

1. How to confront a loss of market share in the senior housing industry?

2. Many current CCRCs were designed for a different generation — and significant dollars will be needed to enhance attractiveness for the future.

3. Single site CCRCs are disappearing.

4. CCRCs need to confront technology needs (and cost), and need to realize there is also a cost to not investing.

5. The ultimate challenge is achieving an equilibrium in governance.

Scott and I tended to agree on some key items, including the critical importance of open, candid and respectful lines of communication between residents, management and governance groups.  We probably disagree a bit over appropriate roles for regulatory bodies.  

Scott made a very persuasive argument that one of the biggest threats to the future of the CCRC market is communities that fail to move forward in a timely manner to renovate existing facilities and modernize operations, in order to make the enterprise attractive and desirable for the next generation(s) of residents. 

Representatives from resident groups at different Erickson CCRCs in Maryland and Virginia jumped right into the discussion, adding additional topics, including “how important are actuarial studies?” Scott pointed to the fact that his company team includes an actuary who assists CCRCs in forecasting.  At the same time Scott added a note of caution about the potential to over-emphasize actuarial studies. My take-away from Scott’s comments was that long-range success is not just about actuarial evaluations, but includes a need for sensitivity to how “price” can affect marketing (and therefore prospects for  new customers). 

Another good question from the audience:  “Are CCRCs prepared for greater numbers of residents with Alzheimer’s?” I think we agreed the answer is “probably not.”

The tough work came after Scott and I departed, as the resident groups were moving into breakout groups and planning sessions.  Their topics included: possible roles in evaluating and advising on finance, living a healthy lifestyle, defining a “concierge” experience for residents, repositioning plans for individual communities, and the social aspects of the dining experience in Continuing Care Communities. 

My deep thanks to the many residents around the country who responded to my call for topics to present to the Mid-Atlantic conference, as well as to the organizers for the opportunity. I will have more opportunities to use your topics in the near future.