Quality and Quantity of Life for Seniors, in Senior Housing

Since my first years in senior housing and health care, and my work way back when with Alwyn Powell (AV Powell, AV Powell and Associates), I have been fascinated by the aging journey in care settings – lengths of stay, health care utilization, quality of life and quantity of life. I’ve supported numerous research studies and read dozens more.

What was learned across my thirty plus years of work is that seniors that enter senior living environments tend to have a longer life expectancy and better health status than seniors residing in the community.

In CCRCs (Life Plan Communities), the results of longer life span and improved life quality was heavily influenced by adverse selection elements. Simply, those entering these environments tended to be better educated, more socio-economically advanced (income, profession), and having had access to medical care as and when needed. The small cohort of seniors in CCRCs were not exactly, a correlating cohort group to seniors living in the community.  One of the best analyses of this cohort was done by Harold Barney and David Bond (two actuaries) issued in May of 2002.  It is available here: CCRC Demograhpic Analysis (confession, I knew Harold (Hal) and respected him and his work immensely).

Today, a new research report on a wider group, dropped from NORC and NIC (National Investment Center). NORC stands for National Opinion Research Center at the University of Chicago.  The report is on the medical and functional status of senior adults and how the same, frames their entry and health status pre and post-entry into senior living.  The report is available here: 20230922_NIC_Frailty_DAC_Chart_Pack_FINAL__revised_

What the study confirmed is that older adults have increased vulnerability to illness and risk of mobility impairment proximal to entry to senior living and for a short period of after entry.  Essentially, the study confirms that the primary driver for entry to senior living is health, regardless of the type of community (including Independent Living).

The longer the senior is in-residence, the more their health improves and the risk of advancing frailty declines.

What NORC confirmed and what we have generally known regarding CCRC residency is that the non-medical service availability such as nutrition, socialization, transportation, exercise and medication management have the biggest, accretive impact on health stability.  Arguably, from my experiential vantage point in my work and in caring for my own parents and my wife’s, nutrition and medication management were the biggest difference makers.

The key for senior housing operators, particularly in Assisted Living and Independent Living, is to consistently adapt services in scale and complexity, to match resident needs.  Cohorts that age in-place present different challenges beyond wellness services, particularly as cognition in the group changes.  The advantages typically found in CCRCs with multi-levels of care centrally located and integrated, don’t exist directly in single care level projects.  The opportunity thus, is to develop service partnerships that can meet resident care needs, in-place.

For providers across all levels, this information should be particularly helpful in assessing opportunities in an evolving value-based care environment.  Housing providers may wish to look at opportunities to form or become part of, an I-SNP (institutional specialized needs plan) or a C-SNP (chronic, specialized needs plan). 

Other value-based plays include partnerships between various providers such as home health and assisted living, hospice and assisted living, home health and SNF, etc.  Strategically, using the data framework in the NORC report and then, developing a similar case-study analysis at the provider level (your organization level) can build a strategic framework for pursuit of value-based care initiatives. 

If readers want more information on the value-based frameworks of ISNP and CSNP, feel free to let me know via a comment to this post.


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