Consider some realities of 21st century Americans.
They live longer than their parents, and they live longer after their retirement than their parents.
Because health care has prevented many pre-retirement-age deaths, Americans live longer with chronic health conditions.
Because Americans are more mobile, many people live several states away from their parents, which makes taking care of them when their health declines more difficult.
Those realities make senior-citizen living facilities a growth industry for the foreseeable future beyond the traditional nursing home.
One company exploring a new senior citizen living model is CRL Senior Living Communities, owner of Centennial Inn, Lakeshore Manor, Bella Vista and Bella Vista Shores in Oshkosh, Island Shores in Neenah, Bellevue in Green Bay, Countryside Manor in Sheboygan, and Woodland Manor in Sheboygan Falls.
CRL, which has all but two of its facilities in Wisconsin, provides “innovative senior housing,” in the words of president Ari Weinberger, “providing a continuum of care starting from independent/assisted living through dedicated nursing care.
“We don’t look at ourselves as custodians of our residents, but as enablers — to improve health, to enhance their lives. It comes down to philosophy. We don’t just have meals because we have to feed our residents; we see meals as a place where we can make a difference in their lives. We don’t just look at activities as something to keep people occupied.”
The fact that people are living longer doesn’t necessarily mean they’re healthier when they decide to leave their homes.
“My concern is that as people stay at home longer, they come into assisted living at a higher stage of acuity,” says Weinberger. “We’re not custodians; we’re here to improve, we’re here to engage. But people are waiting longer. The longer you want to come in, the more challenges you may have.”
The decision to move a parent from home into assisted living often is a stressful event on top of a stressful event, a parent’s failing health.
“We recognize that the decision to trust us with your loved one is a stressful one,” says Weinberger. “It’s something we work with every day.”
1,000 beds to fill
CRL has 630 residents in its 16 facilities in Wisconsin and Illinois. With recent expansions, the company now has more than 1,000 beds, and it is “in various stages of fillup,” with the expectation of filling capacity within 18 months, Weinberger says. The company has 450 employees.
“The economic environment has accelerated the reality that we’ve been seeing for some time,” he says. “We believe that the consumer prefers apartments with full kitchens as opposed to what assisted living usually offers.”
The company opened two facilities in December 2008, and then took over five facilities that were being operated by CRL’s capital partner.
“We’re seeing the ability to enter into markets we may not have been able to enter into,” says Weinberger.
Weinberger believes CRL stands out from practically anyone in the elder care world.
“We believe that the future of assisted living is really in what’s been called ‘independent living,’” he says. “They’re in an apartment; they’re not in some room. They have kitchens; they might never use it, but it’s nice to know it’s there. The physical design plays a critical role in ways that I think a lot of companies don’t recognize.
“Compared to our direct competitors, we’re in line or a little bit above. In comparison to home health, we’re a lot cheaper. We’re providing what we consider to be a much better environment.”
From real estate to health care
Weinberger, the company’s president, worked for a dedicated health care investment bank, working with senior housing companies, including CRL.
“I learned quite a lot of things people were doing right, people were doing wrong, and trends in the industry,” he says.
Weinberger was brought in to take the company to places few in the industry might have envisioned, using such corporate models as McDonald’s and Disney while focusing on the resident and the resident’s family. Weinberger is branding the company as “innovators in health care.”
“It’s a mom-and-pop industry,” says Weinberger. “The top 50 players control about 15 percent of all the beds in the country. It’s a very fragmented industry. A lot of companies grew and then tripped because they didn’t change. We spent a lot of time deciding infrastructure to handle the growth we have.”
“Ari and the corporation had this vision of creating something new and unique, and global in nature in senior living,” says Mark Ellis, CRL’s marketing director. “Ari’s almost like, forget what we were; let’s create what we want to be. We recruited what we thought was the best of the best, and then we brainstormed.
“There isn’t another community group out there doing what we’re doing. This is a whole way of doing business. We don’t take what is today and leave it. We challenge ourselves with two words: ‘What if.’”
Improving care
As with other kinds of health care, CRL facilities use clinical tracking to keep track of residents’ clinical outcomes in such areas as falls, medication, weight loss and medical errors, in comparison with nursing home data to identify clinical areas in need of improvement.
“Quality always leads to good results,” says Weinberger.
The company uses a dedicated caregiver model; “the people we hire to care for our residents, that’s all they do,” says Weinberger.
“We understand that what we’re doing is almost McDonaldization, with the Disney philosophy of customer service,” says Ellis.
“But it’s still a place people call home,” says Weinberger.
The companies’ facilities’ design are “integral to how we care for our residents,” says Weinberger. The facilities geared to Alzheimer’s Disease patients feature high ceilings, natural lighting, walking paths and “areas for them to stay and do activities,” says Weinberger.
Those design elements are key to reducing stress, a “critical element to delaying” the onset of the disease, he says. “They know they don’t remember, but they don’t know what they don’t remember.”
CRL has hired doctors near their facilities as consulting medical directors “to enhance the therapeutic value of our communities,” says Weinberger. The company is piloting a program to use a bladder scanner for incontinence care.
Another innovation is the employment of a financial concierge whose role is to “work with not only prospective residents, but existing residents to help with their financial situation,” says Weinberger. The concierges work with Elder Life Financial, which gives unsecured loans to senior citizens of up to $50,000, and particularly with residents receiving Veterans Administration benefits. “With VA benefits if you fill out the paperwork wrong the first time, you’re denied forever,” he says.
The facilities each employ an executive chef and a sous chef. The chefs hold weekly Food for Thought meetings with residents to find ways to incorporate residents’ favorites into the menu.
“The challenge our chefs are given is to make meals that our residents grew up with, except to make it healthy,” says Weinberger — “meat loaf and mashed potatoes, and how to make it healthy. It is a challenge, but it’s one we’re successful with.”
Activities for residents include musicians and singers, exercise, and even nationally recognized acts brought in via satellite.
The company communicates monthly with residents’ families, not just when a problem comes up. “It’s all about comfort and care for the resident and the family in tandem,” says Ellis.
The company launched its new Web site, www.crlcares.com, in early January, with Skype service to allow residents to talk to their families.
The company markets itself in part through outreach with health care professionals, service organizations, church groups and support groups, to “educate them about the company, about our philosophy, and ways to engage them to come in,” says Weinberger. CRL facilities hold CRL University, classes health care professionals can take for Continuing Education Unit credits.
“We spend a lot of time marketing to professional communities, who them refer families who are in need to us, and then we work on a one-on-one basis in the process we call ‘discerning’ — finding what the family’s needs are and helping them make decisions,” says Weinberger. “It’s not about making a hard sell; it’s about education.”
The company is looking to open two or three new facilities in the Chicago area while “continuing to evaluate” other Wisconsin sites, says Weinberger. “We always start with ‘is this a market that makes sense?’” he says.
The company researches the demographics of potential residents and “the adult child,” along with available sites.
“The number one goal is to grow in a way that makes the most sense,” he says. “We’re looking to grow the company in a disciplined way that supports our brand.”
He would also like to “investigate another market” while remaining committed to independent living and Alzheimer’s care.
CRL facilities
Independent and assisted living: Island Shores, Neenah; Bella Vista, Oshkosh; Bellevue, Green Bay.
Assisted living: Bella Vista Manor, Oshkosh; Centennial Inn, Oshkosh; Countryside Manor East, Sheboygan; Woodland Manor, Sheboygan Falls.
Alzheimer’s and memory care: Centennial Inn, Oshkosh; Lakeshore Manor, Oshkosh; Countryside Manor, Sheboygan; Woodland Manor, Sheboygan Falls.
