Nonprofits Break New Ground

Mission-driven organizations turn their focus to innovation in healthcare, technology and workforce development.

By Jane Adler

Nonprofit organizations are the pioneers of seniors housing. The first communities, dating back to the early 1900s, were affiliated with religious organizations. 

Fast-forward to today and nonprofit organizations are again on the forefront of innovation. Motivated to improve the life of elders, mission-oriented nonprofits are often first to conduct groundbreaking research and develop cutting-edge programs that can also be applied to the for-profit sector.

Recent innovations at nonprofit senior living organizations fall into three categories: healthcare integration, technology and workforce development. Here’s how nonprofits are leading these trends. 

Healthcare integration

Resident acuity is on the rise. In other words, residents are moving into communities at an older age and are frailer.  

According to industry association Argentum, 53 percent of senior living residents in 2014 were age 85 or older, a 4 percent jump from 2012.  The average age of an assisted living resident is currently 87, according to a report by industry association LeadingAge. Anecdotally, operators say that 10 years ago assisted living residents were about 80 years old on average. 

What’s more, today’s residents are more likely to need care for chronic health conditions such as congestive heart failure. 

At the same time, the healthcare system is switching from a fee-for-service model to one focused on value-based care in which providers are paid based on outcomes. 

These macro trends are nudging the industry to integrate healthcare into housing. Healthy residents will have a longer length of stay, which is a plus for operators. Easy access to on-site healthcare is a big selling point for consumers.

Nonprofits are taking the lead to integrate housing and healthcare. Solutions range from launching their own resident insurance plans to staffing communities with physicians. Several examples illustrate how nonprofits are
carrying out this mission.

A new nonprofit alliance called WellSpire began operations July 1. It is a health and wellness partnership between nonprofits WesleyLife and Genesis Health System, both active in the Quad Cities area of Illinois and Iowa. 

The affiliation is expected to better align the efforts of a health system and senior living operator, according to Rob Kretzinger, president and CEO at WesleyLife. The details are being worked out now on how healthcare will be delivered to residents. 

WesleyLife, based in Johnston, Iowa, owns and operates eight senior living communities and provides home and community-based services. The new WellSpire partnership will assume operations of three Genesis senior living campuses. 

WellSpire also plans to break ground on a new senior living community later this year in Bettendorf, Iowa. The group is considering a project in Moline, Illinois too. 

Another example of a nonprofit healthcare and housing partnership is Bridge to Home, an initiative of CovenantCare at Home and the Legacy Health Endowment. 

CovenantCare at Home is the home health division of Covenant Living Communities and Services based in Skokie, Illinois. It owns and operates 16 communities in nine states. The nonprofit Legacy Health Endowment, headquartered in Turlock, California, provides funding to create healthcare solutions.  

The Bridge to Home program covers 17 zip codes in and around Turlock, where Covenant Living also operates a life plan community. 

The program identifies high-risk seniors transitioning home from the hospital and provides 10 free hours of private home care services. The year-old program has hospital readmission rates among participants of 4 percent, compared with 25 percent among the greater population of high-risk elders. 

“We plan to roll the program out to other locations,” says Elizabeth McLaren, vice president of health strategy, programming and health network integration at Covenant Living. 

Another example of healthcare integration comes from Roseville, Minnesota-based Presbyterian Homes & Services (PHS). It owns and operates 47 senior living communities and has five more under construction. Most are located in the Twin Cities area. 

“We have put a priority on the integration of healthcare and senior living,” says Mike Bingham, senior vice president of Optage and Health Reform at PHS. Optage is the home and community-based services arm of PHS. Optage serves 12,000 seniors.

Last January, PHS bought a 50 percent stake in geriatric medical group Genevive. Minneapolis-based Allina Health System retained its 50 percent ownership in Genevive, which serves about 5,500 adults. 

Genevive has 120 employees, including 17 physicians and 23 nurse practitioners who work in teams. 

As Bingham explains, the vision is to provide healthcare to PHS residents through a common provider. ”We expect better health outcomes,” he says, adding that a seamless medical approach will differentiate PHS properties in the marketplace, too. 

The advantage is that Genevive’s practitioners will work closely with building staff to identify medical issues early on and provide treatment to avoid emergency room visits. “Integrated care provides a better resident and family experience,” says Bingham. 

Genevive services are already offered at four PHS communities and will eventually be available at nearly all locations. “The plan is moving forward,” says Bingham.

In 2020, PHS plans to roll out an insurance plan for residents — a trend gaining more attention lately. 

The insurance will be provided through what’s called an Institutional Special Needs Plan (I-SNP), which is a Medicare Advantage plan that provides services to individuals who may reside in assisted living or long-term care settings. 

The prospect of becoming an insurer at risk for patient lives is a big stumbling block for many senior living providers unfamiliar with the insurance business. 

PHS has the advantage of having a concentration of buildings and residents in the Minneapolis market. The area also has a high penetration of nonprofit insurers willing to partner with PHS, says Bingham. 

He figures the I-SNP plan must sign up at least 300 to 500 seniors to create a viable insurance risk pool. Enrollees do not have to live in a PHS building. They will come from 76 campuses, 35 of which are owned by PHS. “Our partners are mostly nonprofit providers,” says Bingham. 

Technology innovators

Somewhat surprisingly, nonprofits aren’t just experimenting with new technologies, they’re investing in them, too.  

HumanGood, a nonprofit with 21 life plan communities and 95 affordable senior living projects, invested $5 million earlier this year in Pacific Health Ventures. The company focuses on healthcare technology start-ups to improve clinical outcomes, optimize workflow and drive new revenues. 

“Our investment is unique in the nonprofit world,” says John Cochrane, president and CEO at HumanGood based in Glendale, California. “We are looking for technologies that show promise to address a need in our field.” HumanGood also provides expertise to the start-ups on the dynamics of senior living. “We can help them adapt tools for our market,” says Cochrane. 

Other groups are funding startups. The Chicago-based investment bank Ziegler, which arranges financing for nonprofits, has two private equity funds backed mostly by nonprofit senior living and healthcare providers. The funds invest in emerging companies. 

Ziegler recently held its second Ziegler Link-Age Fund Symposium, a forum to showcase new and innovative technology solutions in the aging marketplace. About 200 fund investors and company representatives attended the event. Ziegler also hosts “Demo Thursday,” a webinar for startups to spotlight their products. 

“Our fund manager and investment committee are scanning the market all the time for new products,” says Lisa McCracken, director of senior living research and development at Ziegler. Her office is in Lancaster, Pennsylvania. 

An example of a quickly growing company backed by the Ziegler fund is California-based PayActiv. Positioned as a service for hourly workers, the technology allows employees to access money they have already earned before the end of a pay period. The employee pays $5 for each transaction. The service is free to senior living providers. 

Other nonprofits are piloting innovative programs that could benefit the entire industry. For example, Front Porch is a leader in the introduction of voice first technology, the promising use of voice-activated devices to help residents with daily tasks. 

The organization owns and operates 12 senior living communities and is headquartered in Glendale, California. It also operates the Front Porch Center for Technology, Innovation & Wellbeing. The center pilots innovative technology solutions to help Front Porch residents and the older population at large. 

Amazon’s voice assistant Alexa is being rolled out to 20 Front Porch residents at a time. “The devices need to be personalized for the older adult in order to have impact,” observes Kari Olson, chief innovation and technology officer at Front Porch, who also heads the innovation center. 

The devices are programmed to engage residents around their interests, whether it is a hometown radio station, a type of music, sports scores, or messages from a loved one. Six-week workshops are held with residents to train them how to use the device. “Technology has to be thoughtfully deployed,” says Olson.

The experiment has paid off. Feedback from residents and families is positive. Residents have formed Alexa clubs. They’re also helping to fund the program, buying devices for new users.

The next step is marrying Alexa with smart home technology so residents can control the lights and thermostat by voice. “It’s a winning combination,” says Olson. 

Workforce development

With the national unemployment rate under 4 percent, operators have all been hit by the current shortage of workers. The situation is not expected to ease. 

The forecast is that the number of relatives who can act as caregivers will decline because families are smaller than they were 40 years ago. The Bureau of Labor Statistics projects by 2026 that there could be 7.8 million unfilled caregiver jobs. 

Technology is expected to
pick up some of the slack to improve worker efficiency while reducing turnover. 

New software can help predict whether an applicant is a good fit for a job, and who is more likely to stay on the job. Scheduling software can help fill holes in schedules without triggering overtime. 

“There’s a real opportunity to control costs and retain people,” says Cochrane at HumanGood. He adds that the worker shortage will not be solved by one solution, but by many initiatives. 

Two years ago, LeadingAge, the association of nonprofit aging services providers, designated workforce development as a strategic priority. Susan Hildebrandt was appointed as vice president of workforce initiatives to quarterback the effort. “We provide resources,” she says. 

One resource is the Center for Workforce Solutions, which is hosted on the group’s website. It lists successful programs, new ideas on employment issues and a podcast, along with practical tools for operators. 

An example is the turnover cost calculator. Operators can plug in employee turnover data and see how much it costs to recruit and retain workers. 

Looking at the overall trends, Hildebrandt notes that nonprofit operators are focusing more on implementing creative solutions than they are on simply raising wages. “We try to encourage this,” she says.

One-page descriptions of promising practices are posted on the website. 

Here are a few examples:

• Presbyterian Senior Living based in Dillsburg, Pennsylvania, restructured the recruitment, employment and onboarding processes. It cut contact time between application and interview from one week to three days and added an applicant tracking system to manage the process. 

A pre-hire assessment tool helped managers formulate questions. New employee orientation was restructured to concentrate on mission and purpose rather than on routine tasks. A new employee monitoring system provided regular check-ins to prevent turnover due to lack of understanding or need for training.

Bottom line: Retention in the first year of employment increased to 84 percent from 53 percent.

• Elim Care created a resident concierge representative as a way to introduce prospective employees to the field of elder care. The representatives perform tasks that do not require a license, such as accompanying residents to meals and straightening rooms.

Based in Eden Prairie,
Minnesota, Elim partnered with a local workforce training center that pays a portion of the wages. If the representative is hired,
Elim Care provides scholarships for that individual to train as a nursing assistant. 

Bottom line: About 85 percent of the representatives at one site moved on to become nursing assistants. 

• Christian Living Communities in Holly Creek, Colorado, formed a “Keepers Committee.” It is a forum whereby residents and workers meet to study and discuss local workforce issues, such as low unemployment and high housing costs, along with an open discussion on why workers leave the community. Residents also mentor new staffers and assist with recruitment. 

Bottom line: Residents are more understanding of the workforce issues. Turnover decreased to 19.8 percent in 2016 from 43 percent in 2012.