Healthcare Integrates with Senior Housing

ORANGE COUNTY, CA—Healthcare in some form is entering the independent-living realm as communities strive to bring desired and needed services to seniors, experts tell GlobeSt.com. We asked Alan Ursillo, SVP at JLL; Al Rabil, CEO of Kanye Anderson Real Estate Advisors; Dan Prosky, founding principal of American Healthcare Investors and the president and CEO of Griffin-American Healthcare REIT II; Chuck Harry, managing director and director of research and analytics for NIC; and Michael Gaber, COO at WNC; how healthcare fits in with senior housing. Here's what they had to say.

GlobeSt.com: How does the healthcare element connect with the residential element in senior living?

Ursillo: As the residential real estate market continues to improve, seniors will sell their homes and move into senior communities. When the residential market collapsed a few years ago, the independent-living and CCRC segment of senior housing collapsed. Seniors chose to stay at home and use home healthcare as an alternative care method, or they moved in with their children or a close relative. Seniors will continue to downsize as they age, and as long as the residential market remains strong, they will look for communities that fit their lifestyle, are close to their families and give them the ability to meet new friends.

Rabil: It depends which segment you're talking about. It connects very loosely or not at all in age-restricted communities, but overlaps more in acute care. Within independent living, one of the things we provide is a primary-care physician on site and access to all healthcare-related services. As you go to assisted-living, memory care, Alzheimer's, CCRC and nursing homes, healthcare is a dominant feature. In independent living, which we focus on, we want people to feel comfortable and secure and have their healthcare needs attended to onsite. It comes back to convenience and security. As people progress more in their healthcare needs, there's more of a direct overlap, or the equation changes from living with a little bit of healthcare to healthcare as an integral part of your daily existence.

Prosky: In order to create more of a needs-based atmosphere, it goes back to, 'How can I add additional services to generate income and attract and retain tenants?' We're seeing a lot of facilities that were primarily residential starting to add more healthcare services in order to keep tenants and not move them up to the next level. Having nurses and physicians combine to provide care and assist with medication or bringing people in to assist residents with bathing themselves typically would be seen in assisted living, but we're seeing lot of independent-living facilities provide these services in order to keep tenants as long as possible.

Harry: Integration of healthcare in senior housing varies to some degree by the individual communities and they services they provide. Increasingly, the majority of communities ae combination of different care segments: independent, assisted, memory care and nursing care—so that as the resident ages and heir needs increase with different acuity levels, different levels of care can be accessed, but that will vary depending upon what services are provided at each property. There are some independent-living communities that have generally fewer healthcare-related services provided, but at times they will contract with outside services. With home healthcare, providers come to the community to provide the resident with those services within their home. There's a full spectrum of services available, and many residents—particularly those who plan ahead—are asking the senior housing communities about making those services available at the property.

Gaber: Healthcare is carved out of it to some degree. We don't have your traditional assisted living and those types of properties—we have some modified versions. Most of the senior housing in our industry is individuals who are self-sufficient. There are some exceptions, but there many properties in Iowa and other places with some healthcare component. It's voluntary—not mandatory. Some properties have healthcare features associated with them, whether it's a Life Alert necklace or strings in the bathroom that let the manager know they've fallen, but there's no direct healthcare associated with it. The biggest thing with senior housing is how convenient is the healthcare. It's great to have the latest and greatest property, but if you're 15 miles from the nearest hospital or healthcare facility it won't fly. Seniors want to be near healthcare. As they age, they drive less, so a van service to transport them to their doctor is helpful. There are also some situations where a doctor or nurse will come to do basic checkups and check vital signs.