Pilar Carvajal, founder and CEO of Winter Park, FL-based Innovation Senior Living, makes a point during a NIC session. Credit: Tori Sope
HOUSTON—Relationships with third parties, the use of universal workers, pared-down offerings and strict expense control — but not skimping on quality — are keys to a successful senior living model serving middle-income older adults, according to two industry executives.
Pilar Carvajal, founder and CEO of Winter Park, FL-based Innovation Senior Living, and Tana Gall, president of Seattle-based Merrill Gardens, which has the middle-market Truewood by Merrill brand, shared insights based on their experiences Wednesday at the National Investment Center for Seniors Housing & Care Fall Conference.
“There is an enormous opportunity here,” Carvajal said. Indeed, a 2019 study funded by NIC 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.
“Partnerships are key to this type of model,” said Carvajal, a 2019 McKnight’s Women of Distinction Hall of Fame inductee who has two decades of experience serving low-income seniors in addition to experience serving the middle market.
“What I learned in serving low-income seniors is that that middle-income senior is very attracted to that model” because of the great service despite the lack of “bells and whistles,” she said.
Here are some areas to consider, Carvajal and Gall said.
Innovation offers home health, hospice and other services through partnerships, Carvajal said, adding that she tries to work with local companies, with a benefit being that doing so helps drive occupancy through referrals. Pharmacies or therapy companies may work across several communities, she added.
Outside of care provision, Truewood has relationships with area retailers, which helps with programming while keeping costs down, said Gall, a 2021 McKnight’s Women of Distinction Hall of Fame inductee.
Trader Joe’s, for instance, provides flowers, which residents use to create dining room decorations.
“The craft store — you tell them what you’re doing, and it’s amazing what they will donate to you,” she added.
Truewood also takes advantage of the talents of residents and their families, Gall said.
During the move-in process, residents and their families complete paperwork via which they can list the services they could provide. One resident, she said, is a former college professor who now teaches writing classes in a community.
“Because we’re developing this new model, I think the answers are in the residents and the families. …They tell you the answers” about what matters to them, Carvajal said.
In contrast to Innovation’s original product, Merrill Gardens communities are high-end properties serving affluent older adults, Gall said. The Truewood brand was announced in 2019 to serve middle-income seniors.
The average age of the 23 Truewood communities is 26 years, Gall said, noting that the properties were high-end properties when new, and most were purpose-built retirement communities. “What we saw was an opportunity to acquire these buildings at a good basis and be able to service a more affordable product,” she said.
“To keep it the price point we want, I haven’t been able to see how you can develop it from the ground up,” Gall said. “I don’t think we need to.”
The future might see the conversion of extended stay hotels for use as senior living communities serving the middle market, she said.
In the meantime, moving in is “the very practical senior. It’s the one who maybe wants to leave something to their family someday,” Gall said. “They don’t necessarily want the bells and whistles. …We’re just changing the operating platform.”
Payroll is a business’ biggest expense, Carvajal pointed out, and Gall said that Merrill also looks at every other line item in the budget to see where savings can be realized.
Workers at Innovation and Truewood middle-market communities are universal workers who handle needs related to housekeeping, serving, dishwashing and other tasks. Truewood calls the workers “resident experience partners,” Gall said.
A challenge for Merrill, she said, was rolling out the Truewood model in existing communities that already had employees.
“We said, ‘We’ve got a new opportunity for you. It’s this new job description, and we’d really like you to consider it,’ ” Gall said. “And so we have taken a lot of the folks that already worked for us … and now they have more [responsibilities]. We trained them to do more things. And when they’re trained to do more things, we pay them more, because they’re more valuable to me, and that has been wildly successful.”
But it’s not just about money, she added.
Job satisfaction among universal workers is “off the charts,” Gall said. “I didn’t expect that,” she added, and hopes that feeling will translate to reduced turnover.
“This type of product — it feels good,” Carvajal said, adding that many people are attracted to the social impact they can make via the work. “This is a purpose-filled opportunity for these employees,” she said.
Gall cited the case of a Merrill Gardens housekeeper who added caregiver duties to her role and now is on a career path to become a nurse.
“And if we hadn’t thrown that out to this housekeeper, I don’t know if she ever knew that that’s where she would probably end up some day,” Gall said. “And those stories go on and on.”
A benefit of one person performing numerous roles is that workers become very familiar with residents, and vice versa, Carvajal said.
“We find that there’s better care because that employee sees that individual through their entire day — what they’re eating, how they’re sleeping, how they’re bathing and so forth,” she said. “So it’s been a very by-accident type of a thing for me to realize that this is a very effective way to operate that middle-income product.”
Carvajal said that in Florida where she operates, med techs are allowed to do “quite a bit,” so she uses them and certified nursing assistants instead of nurses to save on payroll. “The nursing services that we do provide are third-partied out” to home health workers and a range of physicians, she said.
Truewood’s offerings were influenced by focus groups that Merrill Gardens conducted with seniors and families, Gall said. “Instead of me guessing what was important to people, I actually sat down with family members and with seniors and asked them what was important. …What was a must-have? …One thing that I will keep saying over and over was that quality was never going to be compromised.”
Some of the ways that Truewood communities differ from Merrill Gardens communities, she said, can be seen in the areas of dining and programs and activities. Instead of all-day, made-to-order dining as in Merrill Gardens communities, for instance, Truewood communities have set dining hours and predetermined options for breakfast. Lunch typically is menu-based, and served, with dinner being a lighter meal. This approach means that fewer workers are needed at mealtime, but residents still benefit from the social nature of the gatherings, Gall said.
“It’s managing expectations and providing a great product,” she said.
Carvajal said her middle-market residents are offered simple “meat and potatoes” and lighter meals, with more of a splurge on special occasions such as holidays.
Ultimately — and unfortunately, Carvajal said, “I don’t think we can be everything to everybody. …We are not going to be doing a lot of memory care, in order to keep it affordable. Most of our products are going to be stand-alone assisted living.”
Gall said an assessment at move-in helps Truewood set realistic expectations for residents. “We’re pretty clear up front that we’re probably not going to be doing two-person transfers. We’re probably not going to be doing a lot of diabetic care,” she said, adding that prospects with high-level needs can be referred to an assisted living community or skilled nursing facility in the same market.
It’s important for the sales team to remember, “we’re not going after the same person that lives in a traditional retirement community today,” Gall said. She said she envisions a single or widowed woman who is lonely and not eating well, and who looks forward to bingo at the local senior center.
“When we have her come to our building, we’re not telling her what we’re not giving her,” she said. “We’re telling her all the things we’re enhancing her life with.”
Middle market communities typically appeal to older adults who want more control over their lives, Gall said. “And we’re going to give it to them.”
When it comes to the regulatory environment, states can help the model succeed by allowing med techs to perform many care functions and by not setting resident-to-staff ratios, the speakers said. “Higher Medicaid reimbursement would be great, too,” Carvajal said.