Dr. Bill Thomas believes that the senior care industry’s initial response to the Covid-19 pandemic has been exceptional and inspiring, overall. As the outbreak continues to spread and more positive tests for the virus emerge, however, the next phase of response will tax the industry’s resources in unimaginable ways — and change senior housing and care in fundamental ways.

“We’re going to put our heads down, we’re going to focus on protecting the elders and doing a great job with the staff and getting them the equipment they need and riding this out — but it’s flipping the game board,” Thomas told Senior Housing News. “And after you flip the game board, you have to reset the pieces. That’s where senior living is going to be for the next three to five years — just figuring out how to set the pieces, set up a new game [with] new assumptions, new players, new landscape.”

The immediate next phase of response will need to address issues related to transfers and admissions, the strain the pandemic will place on workforces and creating an environment that does not foster the transmission of the virus long term, he believes.

“The next [two to four weeks], we can all get through that, but [in the] long term, how do we change our practices and our processes so that the virus really can’t spread easily inside senior living?” Thomas said on the latest episode of the Senior Housing News podcast, Transform, sponsored by PointClickCare.

Thomas is one of the notable thought leaders in long-term care, with a proven track record of innovation. He is best known for his work with the Eden Alternative and Green House care models, and collaborated with well-known senior living providers such Holiday Retirement.

More recently, Thomas has become a major proponent of small-home living for older adults with his multi-ability/multi-generational inclusive communities [MAGIC] concept, as well as Minka, a prefabricated home design concept in which small homes are built through modular construction and equipped with technology to help older adults live independently.

Highlights of Thomas’ podcast interview are below, edited for length and clarity. Subscribe to Transform via Apple Podcasts, SoundCloud or Google Play.

On how Covid-19 is being felt among senior housing residents:

In addition to its medical and clinical issues, [Covid-19 is] aggravating, loneliness, helplessness and boredom.

We know what we have to do to sort of battle the virus back. And that does involve greater social distance. So the solution to the virus act aggravates loneliness and boredom. So a lot of professionals are carrying out that social distancing policy, but at the same time trying to focus on keeping people connected and keeping people involved.

The best organizations that I’m seeing out there right now are focused on conceiving of the elders as part of the solution. They’re looking for opportunities to foster reciprocity, and to position the elders and the social isolation.

[Second], we’re seeing a new era of video [and] digital technology that has been kind of floating around the edges of senior living is now 100%, front and center. And I think that will be with us forever. I think that this terrible crisis is actually pulling senior living into the digital era in a way that I’ve never seen.

… Speaking from a clinical point of view, I think that telehealth/telemedicine is here to stay. I’d say to all my friends in senior living, be there. Be there with telehealth, be there with telemedicine, it’s crucial to our survival. The tools exist. There’s some great companies out there. I don’t have any particular views about any single company. But I just want to say run, don’t walk, to getting telehealth/telemedicine capability set up in your building. I’m in contact with a lot of the leaders in the field, and I know a number of them already have that process underway.

On how the pandemic has exposed the workforce pressures facing the industry:

In the short term. There’s going to be lots and lots of people who will take a job at a senior living community. For a lot of there are so many people, for example, in the food service industry, who are now out of a paycheck and have a mortgage and a car payment. And they’re good at what they do. They’re good with people. They are hard working. They have integrity. And in the short term, I don’t really see any problem with senior living filling, workforce slots. There’s going to be millions of people all eager to work in senior living

We have a structural problem where our comparatively low pay and low prestige has led to some of the infection control issues that [have surfaced]. Longer term, as the economy gets back on its feet and starts to normalize, we have to have a different value proposition for staff. And I think it’s going to really remake the occupational role description for people working in senior living after the crisis has passed.

What the pandemic will mean for future senior housing development:

I think we are headed into a time where we’re going to be reading a lot of headlines we would really not like to be reading and they won’t be headlines because somebody didn’t do their job or messed up. They’re going to be headlines that have to do with the virus exacting a very heavy toll on the most frail people. We have to acknowledge that, and we’ve got a lot of public education to do. With Covid-19 in the mix, it’s going to change the equation in terms of how much care we really try to position [care] in the home versus in facilities. That process is already underway, but it’s probably going to be accelerated further as a result of this.

I see an acceleration of a move toward health home and community-based services. I see an acceleration to more distributed models with less of a focus on concentration. I see a shift that is going to be greatly accelerated toward more middle-market offerings, especially given the economic impact this is going to entail.

I see less of a line between the health care system and the home. Health and home are going to be blended in some pretty interesting, new and different ways going forward. Those are all trends underway right now, before the virus.

On the pandemic strengthening the case for senior housing to be part of the health care system:

Senior housing is part of the health care system and needs to be integrated into the system. The idea that it’s not is really damaging both to the health care system and to older people.

I honestly think that the leisure lifestyle vision of senior housing is perhaps going to be eclipsed by a vision of a kind of housing that keeps you happy, healthy and well. Rather than a lifestyle, aspirational retirement lifestyle, it’s going to refocus the value proposition for senior housing around some core variables having to do with health and wellness. And health care has to be part of that.

One of the things I often say when I’m talking to people above us [in the care spectrum] is that great quality health care is necessary but not sufficient. It’s necessary because it’s part of keeping us well, but it doesn’t provide everything we need for a good life. So senior housing is going to have to learn how to blend both the necessity of health care and telehealth with the important additional dimensions that are really rooted in wellbeing.

I would be more worried about the future of high amenity, high-end senior housing based on a leisure concept and more optimistic about a vision of senior living based on a really solid foundational strategy for delivering health and wellness.

On what needs to happen in order to build more middle-market senior housing:

The increasingly large, complex senior housing investments take longer and longer to entitle, build, and sell and we all know that. So the carrying costs on projects are getting higher and higher, and the number of ZIP codes or building lots that really are really suited for a senior living product [are] becoming harder and harder to find that inventory. But if you can pull it off, you get pretty good returns.

The senior living category has been near the top In returns for real estate investment. So I believe that that value proposition is going to be joined by a second different value proposition: we’re going to be able to do a large number of small, low-risk developments that operate at a lower price point. And our return is going to be less than the prestige developments. But our throughput [in] the number of completed projects versus projects attempted is going to be higher, so that our overall risk is lower. And it’s okay to take a lower return because we’re taking a reduced risk.

A big part of that risk premium is related to how many of those big projects don’t go and how many holes you have to drill before you get one built and filled. If you have access to models that produce a more modest product at a lower price point, and are easier to entitle and fill more quickly, then you can take a lower return year on year and have actually a better business proposition and high risk high return.

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