Senior Living Operators Grow Services With Higher-Acuity Residents in Mind

Operators say the average acuity of senior living residents has risen since the start of the pandemic. In 2024, there are some companies meeting resident needs and fulfilling growth strategies by catering to them specifically.

The strategies being put in place vary from operator to operator. For example, Kansas City, Missouri-based Tutera Senior Living builds in areas within its portfolio of 54 senior living communities for the residents who require services that fall between assisted living and skilled nursing.

According to Randy Bloom, president and COO of Tutera, it takes specialized training and new staffing models to achieve.

“We would consider ourselves a full- service, post-acute healthcare company,” he said. “And that means that we have products and services that essentially meet the needs of residents wherever they are in the continuum.”

The prize ahead for catering to higher-acuity residents is higher occupancy and faster margin recovery. Operators of assisted living and memory care communities have a “distinct advantage” to increase senior living penetration rates in the year ahead, and have recovered from pandemic occupancy hits more quickly than their independent living counterparts, according to recent National Investment Center for Seniors Housing & Care (NIC) analyses.

Embracing increasing acuity

Rising resident acuity has prompted many senior living companies to shift what they are doing in operations.

Given its history, it’s not hard to see why Tutera has embraced caring for residents on the higher end of the acuity scale. The company branched out from skilled nursing into senior housing in the last two decades, and today the product types make up an equal split of the company’s portfolio, according to Bloom.

Tutera’s assisted living model caters to higher-acuity residents by taking a highly personalized approach. Bloom noted there have been instances where areas have been created within their communities to fit the gap between assisted living and skilled nursing, allowing them to remain within a community and pay privately. Staff receive specialized training to take the higher level of acuity into consideration.

Another such company is MD Senior Wellness, which is in the process of opening its first community in California.

Owner Dr. Rajesh Kalra said he is looking at more specialized training and care for his staff so they are ready to meet the needs of seniors coming into the memory care community.

“Our plan is to help seniors at all stages of memory impairment in a safe, compassionate and caring environment,” Kalra said. “We actually believe that it is important to have a diverse group of seniors with memory impairment at different spectrums, so that residents can learn from one another, help one another [and] hold each other accountable … basically creating a small community of their own with people under the same cognitive status and memory impairment.”

EF Senior Care, a third-party management company with two communities under operation in 2024, is also looking to apply its skilled nursing roots to senior living.

The Plymouth, Massachusetts-based operator is focusing on providing care services to residents across the care continuum. For example, an independent living resident might spend time in skilled nursing after a hospital visit before returning to their IL unit.

That is a reflection of the fact that today’s senior living residents often have higher and more complex care needs, according to Karen Bain, chief nursing officer for EF Senior Living.

“We’re really trying to provide that continuity of care, streamline the process for having to go to a different facility, trying to keep that within our own facilities and managing that the best we can,” Bain said.

Faced with residents that have higher needs Birmingham, Alabama-based, Atlas Senior Living has partnered with Curana, a company that directly provides health services to residents through a “payvider” method. Under the partnership, Atlas, whose residents have an average age in the mid-80s, is able to provide access to value-based services such as physician services, mobile x-rays and therapy groups in seven communities currently.

Atlas is able to operate those communities more efficiently while handling more care needs for residents, according to Melissa Rost, the operator’s vice president of clinical compliance. One big goal is to keep residents from going to the hospital.

“When we’re talking about a memory care person, it’s very disruptive for them to end up in a hospital setting,” Rost said. “And even even for assisted living, or our independent living residents, when they go to the hospital a three day hospital stay can take them seven to 10 days to recover from and get back to baseline.”

So far, the results of the partnership have been positive and have helped increase resident satisfaction, Rost said.

Other strategies in place at Atlas are focusing on fall prevention and focusing on a “whole person approach” in terms of care and promoting a more active lifestyle. Additionally, Atlas’ staff are mostly cross trained to be able to help out in just about every regard at a community, which Rost said has made a huge difference.

Bain added EF Senior Living will also be focusing on training, staffing and technology investments as it prepares for future growth, along with finding ways to lighten the load on frontline clinical teams and allow them to focus on residents. Collaborations with other providers can also prove beneficial, she added.

“We want to make sure that we can provide the safest environment for the residents,” Bain said. “And I think that creating that role of a community liaison [or] a hospital liaison that is from the clinical team is really going to help enhance a safe discharge and make sure we have all the pieces in place.”

Focusing on the upper end of the continuum

Looking ahead to the rest of the year, Tutera plans to keep its growth strategy in place, as Bloom said the company has a full continuum of care. The company in 2024 is “opportunistic,” and where opportunities make sense they will be evaluated on a case by case basis.

“We’re not saying we know we need to grow in this area,” Bloom said. “We’ll look at those from that perspective, but not follow a specific strategy of trying to grow in a particular area.”

Tutera is also in the process of utilizing technological advancements to better meet the needs of residents. Bloom noted AI has potential to detect patterns of where residents have more needs and predict when they are about to suffer a health event.

Kalra said he is focusing on training the MD Senior Wellness team, and once his community opens, there are plans to expand into other communities to “aid in the assisted living process. Additionally, Kalra’s first community is a 27-bed memory care community, with plans to grow to 40 beds in the coming years and hopes to expand to other communities and services to offer a greater continuum of care, particularly in assisted living and memory care.

“We think that our skill set as well as the gap and care could really benefit from that,” Kalra said.

EF Senior Living is currently looking to grow, and has identified between 12 and 15 communities it would like to expand into, according to CEO Mike Nickolaus, though letters of intent have not been established at this time.

Rost said Atlas plans to expand its partnership with Curana to all 32 of its communities by the end of the year.

The company’s current growth plans include a combination of acquisition, development and management agreements. Atlas COO and President Wyman Hamilton previously told Senior Housing News the company plans to grow through acquisitions over development due to the current capital markets. However, there is no target number in place. When new communities open, the company plans to include access to Curana’s services.
“Our stance has always been that we will never grow just to grow, but we want to put ourselves in a position that when the right next opportunity presents itself, we can take advantage of it and we feel like we are ready for that now when it comes,” Wyman told Senior Housing News.