Hybrid Senior Housing Environments
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Hybrid senior housing environments are senior communities that offer multiple levels of care. They are addressing the reality that as we age we decline cognitively and physically. Initially, you may need some help grocery shopping and doing home maintenance. However, over time, you may need help preparing meals and taking showers. Finally, toward the end of your life, you may need help getting out of bed and eating. To address these evolving needs, you’ll need help similar to that provided in an assisted living facility and in the end, the services provided by a nursing home.
If you want to stay home that means you’ll need to turn your home into an assisted living facility, and eventually a nursing home. If you’re a multi-millionaire, that’s easy. But for most of us, we can’t afford to do that. An alternative is hybrid senior housing.
What Is A Hybrid Living Community?
Communities offering different levels of senior care are hybrid senior living communities. Unlike traditional senior care facilities that focus on one level of care, hybrid communities focus on multiple levels of care.
Senior communities designed to specifically offer a variety of care levels are called continuing care communities. There are communities that offer assisted living services but also have skilled nursing service. In other words, They qualify to offer a wide range of care services.
Some Non-Hybrid Communities Will Bend The Offering
But there are lots of senior communities that offer different levels of care in an unofficial or semi-official environment. Unofficial or semi-official continuing care communities are communities that don’t have as their primary focus continuing care. In other words, they take in seniors with various care needs but cannot and don’t focus on being able to promise permanent housing to every resident.
They try and extend services by allowing residents to bring in caregivers. These caregivers try and supplement what the assisted living facility can do. This approach tends to work well for relatively healthy seniors. It also works well for seniors with dementia. In both cases, the caregiver is able to fill in the needed services. In other words, without this caregiver, the resident would be too much for the assisted living facility. This approach may temporarily fill a gap at the assisted living facility, but over time, the resident usually needs more. To learn more about assisted living facilities, see our article here.
Religious Based Senior Housing Options
All major religions are committed to the elderly. Consequently, most address housing issues. They learn quickly that seniors need different levels of care. Moreover, they address this need with communities that provide multiple levels of care.
For example, years ago I had the wonderful opportunity to work for Dominican Nuns in Nashville, Tennessee. I learned, for example, about their devotion to God and service. I also learned many religious organizations have historically offered seniors in their communities housing. Over time, that housing evolves into multiple levels of care. Consequently, every medium to large city has one or more religious-based or religiously affiliated and managed communities offering multiple levels of care.
There’s a beautiful example in Monrovia, California, called Santa Teresita. A hybrid senior living community sponsored by the Carmelite Sisters of the Most Sacred Heart of Los Angeles. You can see it here.
There are also religious-based management companies that are aggregating senior care facilities offering different levels of senior care within states and among states. For example, take a look at the Episcopal Retirement Services (ERS). ERS provides senior housing with various levels of care across there states of Ohio, Kentucky, and Indiana. You can see their various communities here.
Levels Of Care
The fastest growing area of senior housing are combinations of independent, assisted and dependent housing options. A housing complex that has all these options together or within a short drive. This allows a senior to move into a community once, and receive whatever level of care they need.
Unlike other senior housing options, hybrid housing options combine multiple senior facilities under one plan. Usually within the same geographic area. These facilities include combinations of the services below:
Senior Housing And Health Care Industries Are Combining
Carmen and I cannot emphasize how intertwined the senior housing industry is with the senior health care industry. As a result, this has led to many more senior housing hybrid options. But this may require some history to truly appreciate.
History Of Senior Housing
Years ago, if an Ager became chronically ill and could not live on their own or with a family member, they had limited options. However, there were expensive private facilities that would provide good care for a price. But few could afford these high-end options. They were like a cruise ship with medical staff and caregivers on board, but on land.
Alternatively, there were fraternal organizations and benevolent societies. For example, groups of like-minded persons representing a guild, craft, political ideology, or passion (science, art, literature, etc.). Members would join and contribute funds. These funds were used to help members who needed help when they got sick or old. Sometimes these organizations built homes for the injured, old, and widowed that members and their families could use.
There were also early forms of insurance where people would pay into an organization in return for benefits like housing and money if they could no longer work. However, the bulk of the population was relatively poor. For these people, religious organizations were often their only option. Religious organizations have been building homes for the sick, orphaned, widowed, and elderly for hundreds of years and continue to operate them to this day. Their ongoing presence has led to more hybrid housing options.
History Of Senior Care Leads To Hybrid Housing Options
A few decades ago, if you weren’t rich, you looked for facilities that would take state or federal funds. Most of these facilities were crowded and understaffed. There were also facilities run by religious organizations that also took state and federal funds but were better run but generally limited in availability. Most facilities built decades ago didn’t require hundreds of millions of dollars of capital to build. In the last decade, that has changed. There are still small-scale models of assisted living facilities (e.g., Green House project, Board and Care facilities, etc.), but most strive to address larger populations.
Big Companies Offering More Options
In the last couple of decades, large corporations have entered the senior housing industry. These large corporations were building different types of communities, some for seniors, some for the general public. Moreover, many were building multiple types of communities just for seniors. Many realized those communities could be combined. In other words, if you (the big corporations) built houses, condos, or apartments, why not target seniors?
They had the experience and the capital. So they started targeting seniors, and their initial targets were healthy seniors. They built for healthy seniors and the seniors moved in. Some builders quickly realized that their senior facilities could easily incorporate a common cafeteria. Kind of like college housing. Corporations built these types of environments.
Over time, healthy seniors got older and less healthy creating the need for hybrid senior housing options. For example, many aging seniors need help with transportation and meals. As they reached advanced old age they need help in areas like bathing and mobility. In addition, their senior residents started falling and requiring weeks of rehabilitation. They also needed weeks of rehabilitation. In short, the corporations in the housing industry recognized their residents needed more services, and if they provided these services, they could make more money.
Senior Housing Corporations Acquiring Senior Health Care Companies
The Senior Housing Industry (SHI) quickly discovered that it was relatively easy for them to purchase providers of senior care. Players in the SHI had access to capital. Skilled nursing facilities and nursing homes was fragmented. When capital is abundant and acquisition targets are cheap, you start to see roll-ups. Alternatively, the SHI could elect to build in house expertise. They could simply hire their own nurses and therapists and build their own skilled nursing homes. This immediately positioned them to offer hybrid housing options.
Government policy in the 1970’s started funding local (community) based services for the elderly. These included adult daycare, in-home health providers (nurses, rehabilitative therapists, etc.), and senior transportation services. This fostered lots of small mom and pop providers of adult health services. These mom and pop shops often had trouble selling to other mom and pops but were easy pickings for the SHI.
The Spread Of Senior Services
Once acquired or built they could spread these services to their installed base of seniors creating instant economies of scale. They can use the nurses to provide care in their SNF, and in-home to their independent or assisted living facilities. This increases their revenue stream. It also provides additional services needed by their residents.
Once multiple facilities and their corresponding services are in place, the Corporation or entity can offer these under one plan. These hybrid models go by a variety of names like continuing care retirement communities, continuing care communities, life plan communities, and even assisted living communities.