SAN DIEGO — The April 2019 Health Affairs article detailing the results of a National Investment Center for Seniors Housing and Care-funded study about the need for middle-market seniors housing was the fifth most read article of the journal in 2019, NIC Chief Economist Beth Burnham Mace said Thursday.

As McKnight’s Senior Living previously reported, the study found that 54% of the 14.4 million middle-income older adults in 2029 in the United States will lack the financial resources to pay for senior housing and care, and a combination of public and private efforts will be needed to address the looming crisis.

“That housing was able to be significant enough to garner that amount of attention really shows that the silos are starting to be dismantled,” Mace said. Another sign of the topic’s popularity was healthy attendance at the Thursday afternoon session she moderated at NIC’s Spring Conference, where panelists discussed how to cost-effectively deliver care to middle-income older adults in senior housing.

Operators may be able to form, join or tap into Medicare Advantage plans as a way to provide healthcare services to residents.

Outside of that option, participant Diane Burfeindt, vice president of population health and housing at Presbyterian Senior Living, said her company has found success partnering with organizations that have shared goals. When a local hospital sought to reduce the number of PSL residents using its emergency department for primary care, for instance, the solution was to permit the hospital to locate a clinic within the community. Further, PSL was able to leverage the relationships it had with residents to improve their wellness visit scheduling and care plan adherence, actions that had challenged the hospital.

Collecting data will be important if senior living organizations are to make partners of healthcare entities, the speakers said.

Key metrics that operators must be able to provide to potential partners, according to Kevin O’Neil, M.D., chief medical officer at Affinity Living Group, include hospital readmissions, unplanned hospitalizations, fall rates, antipsychotic use, staff retention, customer experience and cost of care.

Addressing social determinants of health also is an important aspect of care provision and keeping costs down through resident wellness — and sometimes, doing so requires creativity, the panelists said.

At a PSL community in Ohio, residents and volunteers pitch in to provide services such as cooking meals, Burfeindt said. welltowerLiving may make frozen meals available to its middle-market community residents, who could heat them without assistance, speakers noted.

O’Neil mentioned a group of semi-retired physicians in Florida who provide free medical care to older adults. Operators and residents also may be able to tap into Meals on Wheels and other community services to keep costs down, he said.

Noting welltowerLiving’s plans to have minimal staffing to keep costs down at its new middle-market communities, audience member Bob Kramer, NIC co-founder and strategic adviser, said in some ways, trying to find ways to serve middle-income adults is taking private-pay senior housing back to its roots. Holiday Retirement, he noted, began with live-in couples managing the independent living communities, although Holiday communities did not include a healthcare component. One audience member dubbed efforts to serve the emerging middle market “Holiday 2.0.”

At a separate session at the conference, lunchtime speaker Andrew Waldeck, senior partner and healthcare co-lead at Innosight, said any operator that wants to serve the middle market will need to commit to doing so.

“At the end of the day, it’s a choice,” he said. “You can figure out how to make senior housing affordable for the forgotten middle if that is something you commit resources to and you believe that it can be a significant growth business for you over time. If that’s something that someone is assigned to do off the side at their desk, if that’s an experiment, if that’s an early step that you might take in the future, you will not be successful.”

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