“Those that don’t learn from history are doomed to repeat it.”
When I began practicing medicine 25+ years ago, hospitals were the center of the healthcare universe. From the hospitals’ viewpoint, physician offices were just appendages whose role was to feed them with patients. And when the patients were discharged with a list of cursory and usually verbal-only instructions, they were “out of sight and out of mind” the micro-second they crossed the hospitals’ exit door threshold. I should know…I was complicit in all that.
And most physicians were unaware of senior housing and what it actually is (let’s define it as: independent and assisted living). We knew very little (OK…we knew nothing!) about the senior housing communities in our very own cities, even those that were practically within walking distance from us. For most of us, assisted living was “something like a nursing home, but not quite.” Our ignorance about senior housing didn’t really matter, though, because the residents, although fragile and medically complicated, came to us in our offices just like every other patient.
When it came to nursing homes, providing care there was viewed more like charity work. It was primarily done in a physician’s spare time, usually at the end of the day and on his way home from the office or the hospital. Or, our rounding was done on our day off work, or perhaps early and hurriedly on a weekend morning.
Fast Forward 25 Years
What a difference 25 years makes! The worlds of healthcare and senior housing have collided, and neither will ever be the same. And that means both have been thrust into a new relationship to which each must adapt.
For healthcare, hospitals are no longer the ‘center of the healthcare universe.’ Quite the contrary – doctors now avoid hospitalizing their patients if at all possible. And those patients who are hospitalized have a diminishing length of stay, so that a greater burden of their recovery occurs somewhere in the community – home, senior housing, the post-acute care setting (nursing homes, rehab centers, long term acute care hospitals), etc.
And for seniors, whose demographic is experiencing explosive growth, the community (not hospitals) is now the primary focus of healthcare delivery. That means the burden of managing the rising acuity levels of many incoming residents has been set right in the laps of senior housing owners and operators who have no choice but to ‘deal with it.’
By necessity, therefore, the identity of senior housing is gradually morphing, evolving. Now, what previously was an almost exclusive focus on a pure hospitality model has a few receptive and innovative providers budding into an Integrated Care model, one that incorporates a healthcare focus to meet the myriad healthcare demands of their residents.
But this changing landscape of healthcare and senior housing is only in its natal form, and the relevant players are still trying to figure out how to react. As it stands now, most senior housing owners and operators still plod onwards, resolute to hang on to their well-worn hospitality-only model until the very end. Many of them will go the way of the dinosaurs.
Others are beginning to listen and react positively to the winds of change. And the latter inspire hope.
Remember the dot.com bubble? Predictions…
I’ve heard it predicted that senior housing will evolve into either a predominantly hospitality model or an integrated care model that incorporates a focus on healthcare.
But I don’t buy this.
I don’t believe that pure hospitality models of senior housing have a future. So when you look at them, you’re seeing ‘the past.’ I believe these proponents are living in a bubble, just like the dot.com bubble that popped in 2001. And as the needle and the bubble get closer and closer, the only thing that will get their attention is a loud POP!
Integrated Care
Senior housing is evolving into an Integrated Care triad: hospitality, real estate, and now healthcare.
No matter how you tweek the hospitality amenities of senior housing, and no matter how you promote the real estate investment advantages of senior housing to one’s investors, you simply cannot escape the new necessity of incorporating a healthcare focus. You cannot separate seniors from their health.
The New Reality Is A Good Reality
We have arrived at the juncture where the major outcomes of senior housing and healthcare are inextricably linked. And this is good! Profitability and high census is achieved via stabilized resident health and lower overall healthcare costs. Everybody wins.
E-mail me with comments:
st**********@il*******************.com
Dr. Steven Fuller
Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing. This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.
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