Bold innovation drives system-wide improvements in senior housing and healthcare.

Chief among this profession’s most notable trailblazers, in my arguably biased opinion, have been David Freshwater, chairman and developer, and David Barnes, president and CEO, of Watermark Retirement Communities. Here I share, in my words and theirs, why after 30 years they believe they are finally on the cusp of a much-needed revolution in the way senior housing and healthcare is delivered. And how other operators can contribute.

The Hacienda at the River, what they believe to be Watermark’s most ambitious endeavor to date, sits on 7.5 scenic acres of what once was a dude ranch and later a riding school in Tucson, AZ. The assisted living, memory care, skilled nursing and rehabilitation community is designed to look and feel like a hacienda, not a retirement community.

“One of my biggest frustrations is that if I’m on vacation and we’re driving around, I’ll see a senior housing community from the freeway, and I know it is one because it looks like one,” Freshwater said. “We’ve been at this for 30 years, and they haven’t changed that much, and that’s frustrating. At the same time, we recognize how difficult it is to create a model that’s actually progressive. We’ve had to fight a lot of arcane regulations to break the mold.”

To help fulfill their vision for The Hacienda at the River, Freshwater and Barnes purposely sought and hired an architect with no track record whatsoever in senior housing or care environments, to avoid preconceived notions.

Is Freshwater pleased with the results? “Yes. I always see something I want to improve, but it looks nothing like a nursing home,” he said. “It is welcoming. That’s a crucial foundation for what we aim to accomplish here in the years ahead.”

“You never get to do everything you want when developing, but it is important to keep pushing boundaries with the city or state regulators,” Barnes added. “When you’re trying to create outside the box, that can be challenging, but we’ve made great strides, and the end result is extremely rewarding.”

Historically, Watermark has acquired existing buildings, so Barnes said he found it “immensely rewarding” to design a community from the ground up.

It started with horses

Equine therapeutic programming is a key component of Watermark’s new model of senior care.

In the Presence of Horses, a research-based program developed for Watermark and led by Barbara Rector, promotes physical and emotional well-being through touch, grooming, interaction with, and — for some — riding of the horses. Residents and their families already are seeing the benefits.

And equine therapeutic programming is only the first of many practices being introduced at this community.

“When Barbara Rector told us she was working with the University of Arizona on a study about the hard science of the human and horse heart connection, light bulbs started going off,” Freshwater said. “Through conversations with our longtime university partner, Evan Kligman M.D., a noted geriatrician and leader in healthy aging with the U of A’s Center on Aging, we discovered cutting-edge university research immediately applicable to our efforts. Then, digging even deeper, we eventually uncovered ways we could potentially partner with many different departments and colleges at the U of A to embark on groundbreaking new studies about how to stave off illness, heal more quickly from ailments and live better in later life.”

University connection

Freshwater first met Kligman in 1987, the year Freshwater opened his first retirement community, The Fountains at La Cholla.

Through Project Age Well, Kligman helped Freshwater establish what may have been the first wellness clinic in a retirement community setting. This affiliation enabled Kligman and his colleagues to conduct longitudinal studies on conditions such as osteoporosis.

When first formulating plans for The Hacienda at the River, Watermark engaged Kligman to be its “navigator” through the university. “His introductions acquainted us with key researchers in many different areas with direct and immediate application to our vision of helping residents thrive,” Freshwater said. “Through these relationships, we started looking ahead to how we might play a role in discovering that next big thing. We’re very excited about that win-win-win kind of partnership — win for our residents, win for the university, and win for aging well, overall, at The Hacienda and beyond, nationally and globally.”

Thanks to Kligman’s introductions, Watermark was invited into the University of Arizona’s Bio5, an aging research collaborative.

“We are the only nonscientists in the group,” Freshwater said. “The monthly meetings have been eye-opening for us as practitioners as well as for the academics in the room. The potential outcomes from partnering on well-being advances are immense.”

Watermark’s growing partnerships with the U of A Arizona Center on Aging, the U of A College of Nursing’s Integrative Nursing Faculty Fellowship and the U of A Evelyn F. McKnight Brain Institute, to name a few, will enable the study and documentation of the effects of any number of factors related to wellness, from healing interactions with horses to health-promoting whole food diets to whether lighting can dramatically decrease the severity of sundowning syndrome.

Other benefits to The Hacienda residents are expected to come from a Watermark-sponsored Evelyn F. McKnight Brain Institute satellite center on site, the first in retirement community setting. Faculty and graduate students will be available to educate residents and community associates, conduct neuropsychologic assessments on request and coordinate with care teams for the purpose of applying research-based advancements in brain health. The satellite center is planned to eventually provide neuropsychologic assessment support services and recommendations to the public as well.

In addition, through voluntary practicum and doctoral student involvement at The Hacienda, the U of A College of Nursing’s INFF faculty and students will empower residents and guests to become true partners in their own healing, providing education to help The Hacienda’s rehabilitation guests better prepare for their discharge to home.

“For a 90-year-old, a trip to the emergency department can be a death sentence. Doctors know it, but it’s systemic failure. That’s why we’re working with the College of Nursing and Center on Aging to make The Hacienda at the River essentially a more nurturing alternative to in-hospital recovery, so that patients receive the care they need, whether it’s imaging or acupuncture, in a gentler, healing environment, without all the transportation challenges, bright lights and alarm bells,” he said.

Shaping the future

Freshwater and Barnes said they want their efforts today ultimately to lead to transformation in the entire industry, nationally and globally.

“This matters far more to us than creating a competitive advantage,” Freshwater said.

Both Davids encourage other senior housing operators to explore their own university research initiatives, to help move the profession forward even faster and make the coming decade one that heralds immense improvement and advancement in aging well and healing.

“One of the challenges universities have,” Freshwater said, “is finding partners for high-quality, long- and short-term research studies. Senior living professionals can offer large populations of volunteers willing to participate in life-changing studies. Operators need to avail themselves of these university relationships. It does take commitment, but the payoff is immense.”

Barnes added: “We’ll be able to study the results of these programs and move them beyond anecdotal tests to outcome-driven programs. It is one thing to think a program is the right thing to do but quite another to conduct studies over months and years and witness benefits to individuals, communities and whole societies.”

June C. Hussey is public relations manager for Watermark Retirement Communities, Tucson, AZ

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