Thought leader tries to move care of our seniors forward through various foundations and workplaces.
By Jeff Shaw
If you’re not familiar with Dr. Bill Thomas, you simply must not be paying attention.
Whether it’s his TED Talks, movies, charitable foundations or his work with companies such as AARP (formerly known as the American Association of Retired Persons) and Holiday Retirement, Thomas has made quite a name for himself in the seniors housing industry.
Thomas currently serves as innovation officer at Lifespark, a Minneapolis-based “whole person senior services company.” He has been part of the company for years, serving on their advisory board and most recently as the architect behind Lifespark making a big move when it acquired Tealwood Senior Living and its 35 communities.
At the time of his hiring, Thomas was billed as “a key architect in designing the new model that will deliver a new experience under the Lifesprk Senior Living banner.” (The company has since added the “A” into “Lifespark.”)
Seniors Housing Business sat down with Thomas to discuss his view of the seniors housing industry, how he fell in love with it, and where it needs to go in the future.
Seniors Housing Business: Tell us about your career path and how it led to you focusing on seniors.
Bill Thomas: I started my career path in medicine — I’m a medical doctor. I attended Harvard Medical School, graduated from there and did my residency in family medicine.
I thought I was going to be a family doctor, but I took a part-time job as a medical director of a nursing home and really fell in love with the people and the work. So, I added a certificate in geriatrics, left my family practice and became a geriatrician.
Very early on I could see that while high-quality medical care was necessary, it wasn’t sufficient. I’m all for people having access to necessary care, but I also understand we must go much further than that.
I began working with my wife Jude to experiment with culture and new ways of thinking about senior living. We founded the Eden Alternative in 1992 and it kind of went from there.
SHB: A wide variety of companies have employed you since then. Can you give us some insight into those companies?
Thomas: The mix of companies I’ve worked with is something I think we should actually see more of. I did extended stints with AARP, Kimberly-Clark, Holiday Retirement, Amazon and now with Lifespark.
It is important to get experience inside and outside of the field of senior living. So, I’ve done a significant portion of my work related to issues and problems that don’t bear directly on senior living. One problem our field often contends with is too narrow of a focus and not enough breadth of experience.
SHB: How has this diversity of experience informed your approach to seniors housing?
Thomas: It puts more arrows in my quiver. When you see, for example, how AARP thinks about public policy and how it frames issues and the rigorous work the organization does to develop its messaging, you’re really witnessing world-class policy action and advocacy. I worked with AARP for 20 years. The organization taught me a lot that became very helpful with the Green House model. Its success depended to a large degree on successful advocacy and public policy work. The fact that I spent this time working with AARP helped prepare me for some of those challenges.
At a company like Kimberly-Clark, which manufactures packaged goods, there’s a discipline of thinking about the customer and how to approach unmet needs of the customer. It’s not whatever you feel like doing that day, it’s a rigorous process.
I got to work with Kimberly-Clark’s innovation group, which put more effort into understanding the customer in a day than some senior living organizations do in years. That’s something we really miss out on.
Too often in senior living we think we have the answers, and that people simply don’t understand that we have them. That’s instead of starting with the person and what he or she wants and how we meet that need. That’s what Kimberly-Clark does, and then it innovates. Kimberly-Clark is not just saying, “We’ve got these products, how do we get people to buy them?”
I also did some consulting work for Amazon. In particular, I helped the company explore the senior space. As a tech company and an online retailer, Amazon is interested in the same people we in senior living are interested in, but from a different point of view.
In senior living, we think of a segment of people’s lives where they enter into seniors housing. Amazon thinks of a customer’s life journey. The company has a broader perspective of what it means to be in a relationship with a customer. In the senior living industry, we have to build trust with customers who find themselves in a very different life situation very quickly. They have very little experience with us, and decisions have to be made very fast.
Amazon cultivates a relationship with a customer over a long period of time. As a result, if you’re looking for some product you want to buy, you do all your research online and then go to Amazon to buy it. You could have bought the product 10 times during your research, but you go to the established relationship.
We don’t do that in senior living. We’re always going through a rushed process.
Rethink the model
SHB: What is Lifespark’s model and how does it differ from the status quo?
Thomas: Your readers don’t need me to summarize the status quo of senior living. They are out there every day operating senior living properties, doing a great job taking care of people.
The senior living industry we have today is founded on a small number of very specific revenue streams that haven’t changed in 60 years: private fee-for-service, Medicare and Medicaid, and a pinch of commercial insurance. The funding that supports senior living has been frozen in time for more than half a century.
What makes Lifespark different is it opens another side of the wallet. It brings another category of revenue into the mix. That’s what we refer to as value-based reimbursement.
In other words, there’s fee-for-service products. For example, you have a sore throat and you go to the doctor and he does a test and there’s a bill and you pay it. And then there’s ‘value-based’ reimubursement, which is based on keeping people well, wherever they live — moving from volume to value. The right score card is not how many office visits you generate. It’s how healthy people in a population are.
Instead of us saying, “We’re going to go out and build 20 new buildings with new architecture and great amenities and it’s going to be really cool,” we’re saying, “We’re an ally of senior living and we have the tools to open up another side of the wallet and add a new revenue stream to help the bottom line.”
SHB: What does that look like on the front lines?
Thomas: What we do at Lifespark is we look at the current, absolutely crazy, insane, impossible-to-navigate healthcare system and we bring into focus an alternative delivery system based on the home and the community, not the hospital. That means we are able to offer people access to a complete healthcare system that isn’t based only on acute medical care, but includes health and wellness in the community, too. It’s the right services, at the right time focused on better long-term life experiences.
It means home services, late-life care, primary medical care with geriatric experts — all the pieces that people use in their homes and communities.
The second thing, and it’s what makes Lifespark unique, is that we complete that network with financial insurance products that pay for it all in the context of population health.
(The American Hospital Association defines population health management as “the process of improving clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models.”)
Let’s say you have a regular Medicare program, and you have this provider over here and that provider over there, and they don’t talk to each other. The money from your insurance comes with a lot of work to navigate those providers. With participating health plans, we give people access to a complete integrated team — one point of coordination for a better experience to keep costs down and outcomes high.
It makes it almost hard to believe — you can access a better system, get more benefits and not pay more money. The existing system is so dysfunctional and wasteful, you can deliver better service that’s focused on the person for the same or less money.
Our friends in senior living currently know almost nothing about population health. They’ve heard of it, and they know Medicare Advantage, and some pioneers have put together plans. But if you back up and look at senior living as a whole, there’s virtually no understanding of how population health can improve life for them. Lifespark teaches senior living what population health is and how the industry can use it to improve the health of the people living in their communities.
SHB: For years, you’ve been pushing for more technological innovation in an industry that frequently is resistant to such changes. What innovations are needed in the home, including senior living apartments, to meet the needs of seniors?
Thomas: When it comes to technology in senior living, we’ve had low levels of adoption, low levels of penetration, and little ROI (return on investment). The question is: Why?
If you’re a musician, your pedalboard, your amps — everything is getting better, easier to use, lighter to move, easier to set up. But then you look at senior living and there’s not this comparable revolution in technology. Why aren’t we seeing that?
The joke answer is I blame grandparents because there are 10,000 engineering school graduates whose grandparents had some problem, and those engineers made a product to solve that problem, and that led to 10,000 gadgets, none of which work with each other, connect or are user friendly. We have an overdose of ineffective gadgets.
On the other hand, what we need are really simple networked tools that replace labor in ways that enable humans to spend more time being human with the people in the community.
Here’s the tech I want: I want a robot that can clean a toilet and make a bed. If I had robots that cleaned toilets and made beds, I could take my labor and direct it toward the relationship building and human connection that is really the heart and soul of our value proposition.
But I don’t get that robot. I get cuddly seal robots and pill dispensers. All of them are clever in their own way, but none address the most important need, which is human
connection. Humans need to do less of the routine work and more of the human connection work.
Make a change, and move on
SHB: Tell us about various organizations you’ve founded.
Thomas: My wife, Jude, and I founded The Eden Alternative. I’m very proud that it is healthy and continuing its mission of transforming the experience of aging. We’ve transitioned out of operations.
We’re part of the founding team at Pioneer Network, which continues to work without our direct involvement of educating people about culture change. (The goal of the Pioneer Network is to help care providers transition away from the medical, institutional model of senior care.)
The Green House Project has grown, and now it’s coming up on 20 years and is operating on its own without our involvement, which makes me very proud and happy. (Green House homes are a small-house senior care concept, most of which are licensed skilled nursing facilities, emphasizing a smaller, self-contained and self-sufficient concept.)
We founded an online communications platform, Changing
Aging, which has accomplished a lot including organizing a 25-city theatrical tour. The website’s still active, but we’re not touring any longer due to COVID.
And then I founded a company called Minka, which began as a company making and selling prefabricated small houses for elders and has emerged as a company that is organizing the creation of elder-focused communities. We’re starting in Colorado and Texas. We’re still involved in the management of Minka. We’ve got a great team and will continue to see that grow.
Developing organizations that can deliver solutions is the thread that connects all of this. That has been more important to us than empire building or maintaining control over an organization. We start things, build things, grow things and then turn them over.
There are so many pieces of the puzzle that need attention and work. Jude and I started on a purely cultural innovation with the Eden Alternative, then worked our way through Green House and public advocacy, and now Minka. Now what we’re trying to do is get senior living connected to population health management at a larger scale.
Everybody has great ideas for new architecture and technology, but if you don’t have the revenue, you can’t do it. Lifespark is a crowning piece of my career’s work because it has the potential to inject new revenue into the field in ways that can improve the health and well-being of older people.
SHB: Seniors housing is a bit complicated in that we’re trying to serve our most valuable members of society, but it’s also a business that must turn a profit. How do we marry the mission with the business goals in this industry?
Thomas: I divide it up this way: One group of leaders and entrepreneurs has solved the question you posed by moving up the income scale and focusing on meeting the needs of wealthy people. I have no trouble with that — that’s great.
I have been influenced by Bob Kramer (co-founder and former CEO of the National Investment Center for Seniors Housing & Care and now a strategic advisor to the organization). He makes the point that if you want to shape the future of seniors housing, you’re going to have to serve the middle market and develop tools that allow the American middle class to have access to senior living.
This is where that business case meets the social-good case — it’s in the middle class.
If you look at the opportunity to marry new revenue from population health with a commitment to supporting older members of America’s middle class, you can make a business case.
That’s the largest segment of the future of the senior living industry. Our ability to meet that challenge will define the success of the industry.
SHB: Do you have any ideas to help the industry face the labor crisis, which seems primed to only get worse in coming years?
Thomas: I’ve been really inspired and influenced by the folks at Bickford Senior Living. Their leadership makes this point: For years we’ve refined our ability to present our value proposition to older people and their families, get people to move in and benefit. We need to develop the same capability of marketing ourselves as a place to work. The field has not done that.
Everybody recruits employees, but we need to market in the same way, with the same rigor that we use to find residents to live in the communities. You have to use the same tools and expertise.
Bickford has hit the nail on the head. What we need as a profession moving forward is to elevate that marketing capability for the workforce.
When elders don’t move into your community, you don’t say, “Stupid elders, why don’t they move in?” You wonder why you’re not reaching them. When people don’t come to work in your community, you need to take the same approach.
SHB: What is something people in the industry would be surprised to learn about you?
Thomas: I love rowing. Rowing is a very technical sport. My wife asked if I do my thinking when I do my rowing, and I don’t. It’s too technical. It stops me from thinking, which is so great.
I do indoor rowing right now because of the weather, but I’ll do 20 miles after this interview, and I will not be thinking about senior living or anything else.
This is one of the problems we have in senior living: People think too much about it. If you want to start finding answers that are not ordinary and obvious, stop thinking about senior living. Open up an empty space for new ideas, new perspectives and new points of view to drop in.
Mentally the best thing about rowing is it creates a mental vacuum. Then, afterward, it’s easier for ideas to come in.
I live on a lake that’s 38 miles long. I have lots of opportunity. When the weather is nicer, I walk out my front door, put my boat in the water and row.