Residents learn to deal with death and navigate relationships
By Joel Mendes
I have spent the majority of my career as a lender to the seniors housing industry. In my efforts to provide capital, I have been fortunate to tour many properties and meet some exceptional operators. Recently, however, I was exposed to an entirely new perspective on the business. A relative of mine is a 64-year-old, highly educated, mentally sharp resident in an assisted living facility. Let’s call her Diane.
Diane was retired and happy when, in 2013, she was diagnosed with a condition that caused her legs to swell considerably. She could not walk and was in a great deal of pain. Strong-willed and determined, Diane refused to allow her family members to take her into their homes. At her request, she was discharged from the hospital to the assisted living facility in which her mother had lived her final years. The stay at
the assisted living facility was intended to be temporary until the treatment for her legs was complete.
Diane is by far the youngest resident in a facility with an average resident age of 90 years. While her legs still cause her pain and are not fully functional, keeping her in a wheelchair, she is as smart as they come. Below is an account of the insights she provided that may be of interest to other industry stakeholders.
Navigating different relationships
The primary owner of the facility is an individual owner-operator who lives approximately 100 miles away and also operates several other facilities in the state. While Diane feels a great connection with the on-site staff, she feels no connection with the corporate owner. Diane has never seen this individual, but heard that the owner has attended staff holiday parties. I informed Diane that this circumstance was not necessarily unusual, but many operators, be it a family business or large company, try to impart their values on staff and residents, which Diane felt was a nice-to-have as opposed to a need-to-have.
Diane is amazed at the care being provided to her and her fellow residents. She feels truly grateful. Most of the caregivers are unmarried women, with children, making less than $10 per hour. They work hard and are caring and supportive. Diane admires them. However, turnover is constant. Some of the other residents, who are generally much older and from a different generation, treat the staff poorly. These residents appear to not realize how difficult it is for the staff to perform their duties day after day in order to support themselves and their families.
Diane has been fortunate to form meaningful friendships with some of the other residents. Her best friend is 93 years old, whom she met at dinner. Something unique about this property is the assigned seating at meals. Diane eats with the same folks at the same table every day. This is a blessing and a curse. On the plus side, it helps to mitigate the childish exclusionary culture of cliques and popular crowds that is so prevalent in seniors housing properties. Generally, Diane enjoys her tablemates. However, there have been a few exceptions over which she has no control.
Given her relative youth, full cognition, and penchant for candor, Diane was selected to represent the resident base at monthly meetings with facility management. She held this post for a year before voluntarily resigning it. One of her early accomplishments, to much fanfare, was to add the option of butter at meals, as opposed to just margarine.
Diane has observed that some residents feel they were “tricked” into living in the facility, and still comment that their stay is only temporary.One notable example involved a woman whose daughter asked her to live at the facility for a month while she was away in California; when the daughter came home, the mother remained at the property. Some adult children are overly dedicated, driving over an hour each day to see their loved ones. On the other hand, some adult children only visit their parent briefly, oftentimes impolitely interrupting meals for an obligatory 20 minutes.
Weighing the positives and negatives
The hardest part of life in an assisted living facility for Diane is seeing so many people die. One man died next to her in the dining room while eating breakfast. Diane’s neighbor died at 3 a.m., which Diane witnessed through muffled sounds coming from their shared wall. During meals or activities, someone may be wheeled out of the front door, while the other residents must do their best to go on about their days. Diane, of course, remembers everything vividly, including all of her personal interactions with the deceased.
I informed her that facilities are now being built with back doors to reduce the effect of death on residents, which she thought may help those with less awareness, but would not make much difference to her.
In Diane’s opinion, the single greatest benefit of living in an assisted living facility is the feeling of safety and security at all times. She never has to worry about intruders. If she falls, someone will be there to help. These are important considerations to anyone otherwise living alone. Unfortunately, the availability of these benefits requires the loss of a certain amount of privacy. One must live with a few knocks on the door throughout the day, which seem to come at inopportune times. Sometimes she just wants to be left alone.
The building has a secured memory care wing separate from the larger assisted living areas. Diane has never been inside. Jokingly, she and her resident friends refer to the memory care wing as “back there,” as in, “You better make sure you remember what day it is Daisy, or they’ll send you back there.”
Diane is happy with her living arrangements. She understands that dealing with death is a part of life in seniors housing and that staffing difficulties are a function of the business. While most of her “contemporaries” are 25 years older than she is, many of them are still fine card players and dinner partners, and now friends. In all, Diane’s story is a positive reflection on the seniors housing industry, and I continue to be grateful for the care being provided by seniors housing operators nationwide.
Joel Mendes provides capital solutions to seniors housing owners and operators nationwide as a senior vice president in Oak Grove Capital’s Seniors Housing and Healthcare production team. He is a regular speaker on industry topics at state and national levels, and periodically writes market update columns on seniors housing finance.