Aging in Place vs. Senior Living | Ryan Frederick (Here) and Michael Owens (SLIF) in conversation

Good morning. Mark Twain famously said, "The two most important days of your life are the day you were born," which I'm not going to disagree with, "and the day you found out why." Mark Twain was— most of the bulk of his life, he lived in the 1800s. The average life expectancy was less than 40. People didn't live long when Mark Twain was alive. But we live in the age of longevity now. They say that half of the kids born today will live to at least 100. If you're educated, have resources, your life expectancy will continue to rise. Financial advisors in this environment for people in their 50s and 60s, they're suggesting they should plan for to live to 100. Where this is a new normal. And in this modern era, I believe the answer— you don't have a— it's not just one why. When you live this long, you have multiple whys. And I believe that finding your place is foundational for healthy longevity. I'll repeat that: finding your place, I believe, is one of the most, if not the most important decision you make— set of decisions for living a long, healthy, socially connected life. I mean that quite literally first. Where do you physically live? You look at the research on healthy longevity, about 80% of it is linked to environment and lifestyle. It's really a small minority is linked to your DNA. So decisions we make have agency on what our outcomes look like. Joe Coughlin wrote an article last week on Forbes where he said your zip code is the single biggest indicator of your quality of life as you retire. But I don't just mean finding your place literally. I also mean it figuratively. Are you with your people? Are you doing what you're passionate about? Because see, in this longer life, this question comes up time and time again, these different transitions. It happens across the age continuum. What college you go to is a decision about place. Where you decide to move for your first job is a decision about place. Where you then, when you, if you meet a partner or spouse, however, like where you decide to live, where you raise your kids. And then as you progress, where do you then, when you become empty nesters, what does that look like? What do you then retire to? Like, these are all questions about finding your place metaphorically with your people and belonging. And it may even be that you, your stage in life, you're looking after loved ones, you have a health event, maybe there's a divorce, there's a health event, and so on, where again, you've got to find your place. So I believe that this idea of finding your place is foundational for healthy longevity, and this creates an opportunity for senior living. We can bemoan, understandably, the issues around inflation, labor, disruptive capital markets. That's all real. But when we look at the state of our society right now, there are these felt needs that we can meet. There's a recent study on belonging, a national study. It found that only 26% of people have a sense of belonging in their local communities. There's an article that was written earlier this week, just over the weekend, by the current US Surgeon General where he said one of every two people can show measurable signs of loneliness at any moment. This is in the water of our society right now. So as we think about what's the value proposition, you know, for senior living, I think we're best if we lean into these opportunities to create better purpose. To create social connection, that allow people to cognitively understand, emotionally connect, to say, pay attention to this particular decision, to help them find their here and not necessarily I have to move over there. And I believe as we go help people make these important decisions, this idea of finding your place and making the right decision about where to live at the right time in that chapter of life is indeed one of the most important days of your life. Thank you.

So on the topic of place, I guess, as I've mentioned, I live here in Austin and it wasn't a, it wasn't a planned move. It was, it happened during the pandemic. There were no events going on. So I said, hey, let's go on an adventure and travel around. So I went to Florida for a bit. Loved it there, but then came here with my family and we really liked it, but again, it was a temporary thing. But then I knew Ryan Frederick was living here and we didn't know— we know each other, I guess, from Sliff, but not that well. But of course, when I'm here, we reached out and him being the expert on place, we had lunch one day and we were talking. I'm like, I think I can maybe actually move here. And it's all his fault, man, because he was like, listen, think about where you are, where the place you are in your life. And obviously I'm happy that you did convince me to— to do that. Well, obviously other factors convinced me, but what you were just talking about just now was something I wanted to get into on the panel yesterday, but I wanted to save it for today. You know, from— we have these conversations here at SLIF about place and, you know, the value proposition that senior living brings to the table, but I don't really see many operators really talking about how they, you know, place beyond being a physical place, because place is not just, you know, a place you're going to live, but it's where the place you are in your life So what do you think, you know, when you look to senior housing providers, like, what could they be doing better to tell their story?

Well, I'm glad you're here in Austin. In fact, recently Michael became a homeowner, so that was like—

well, now it's, now it's legit. Now it's like, now I'm paying taxes here.

Yeah, yeah, yeah, real estate taxes are real. So this idea of bearing the lead, yeah, like, I think I thought yesterday's conversation was great among the CEOs, and it spoke a bit to just the complexity of this business. It's really, it's complex, it's getting more complex, has to be complex unfortunately. When you look at the success of Apple, for example, they went into the complex and then did the really hard work to get simple on the other side. Not simplistic, but simple so it worked for people. And I think in the work that I'm doing as I advise different companies and the consumer content I'm creating now, I'm learning more and more that people are struggling with exactly what you said. Like, I'm living longer, like, where should I be? Literally and then figuratively. And if we don't have as a field, if we don't lean into that, we're like tone deaf around these really, I mean, the most important things in your life. And so if the conversation, if the marketing, if the conversation in the leasing or sales center goes directly to services, goes directly to granite countertops in the kitchen. Like, we're missing them. And they, as I said, in the macro data, people like are craving these things. Yeah. And we have the opportunity to kind of curate. Not everyone's going to say, I want to make your place my place. But if we don't even have that conversation, we list, we move, lose the opportunity to create this special connection.

So, you know, when I, when we have, when I have conversations with CEOs or operators in general talking about content, some of the speakers, they have a lot of great things in the pipeline and they've got great stories. But again, I go back to, well, like, I go on the websites of some of the providers and I'm like, there's nothing there talking about purpose and meaningful living and, you know, lifespan and wellspan. So, you know, there's great stories to be told and I think it's, You know, I think that the industry to a certain extent should be definitely talking about that more. But you and I, you know, since we live close together, we meet up for coffee and we talk about things. And you said something the other day, and again, it's— I'm sure it's been said at a lot of other conferences, but we need to stop saying the word resident. And so can you elaborate kind of on your thoughts on that?

Yeah, I mean, I think terms matter, right? I mean, I think we have a situation where, you know, going back to the theme of being truly socially connected in the sense of belonging. Like, reside— resident is a derivative of reside. Reside is to really just be there, not necessarily be present, anchored, rooted. And we're losing opportunities for depth around what the expectation is of what this can be. We've lived in, you know, a number of different areas, and we were in Baltimore before we moved here to Austin 4 years ago. And we would host this block party. We would get, you know, a water slide for the kids. A guy built like a kegerator thing for us. We had a parent band. We didn't do that every year based on some feedback, but we didn't hire someone, right? This was like, okay, let's block the street. Let's invite, make it intergenerational. Let's have people. We had agency in creating this environment. We knew our neighbors because design helped, but we prioritized that. So I think what can happen when you use words like resident, it can be deflating, it can take agency away. Whereas I know there's a colleague of ours in the industry, Jill Vitale, awesome at Christian Living Communities, where she talks about citizen. And I think that incrementally is a better way of— look, there's rights, There's opportunity. So I think there's terms here which reinforce this historical narrative that is at odds with creating this sense of belonging. Yeah.

All right. So we got to use citizen now and we can't use affordable, attainable.

Yeah.

And also the word engagement. You know, we had a conversation around that.

Yeah.

You know, what do you think we should be saying instead of resident engagement or citizen engagement?

Yeah, we had coffee the other day. We had an in trouble with both of our wives because it was a very long coffee.

And I think the people sitting next to us were like listening to our conversation, like, what are these guys talking about?

So again, engagement, that framing of it, it's not awful in some respects, but I think this, the idea that we're trying to get people to engage versus giving people the keys like they've had their entire life to go live out this next chapter that doesn't lend itself to a static activity calendar which is conjured up by the activity coordinator, which by the way, I mean, I know a lot of people love the activity coordinator, so I'm not trying to say activity coordinator, but what I am saying is that what if you flip this upside down like it is in the rest of people's lives? And say, hey, what do you want your life to look like? How can we give you the keys? In what ways can we just enable, empower you to create your neighborhood, cultivate your sense of purpose? So again, these different terms reinforce this historical narrative.

Well, I think that's what Chris Bird was saying yesterday at LCS at Sagewood, that they really empower their residents to do the program, and they're all, you know, And that's what he said he'd like to see, of course, throughout the rest of LCS and leaning more into that.

And I bet that happened by accident. I haven't talked to Chris about it. But I bet what happened was you had these educated, motivated, healthy people. Yeah. This is just their new address. And like, get out of the way. We're going to do it our way. I have a— I'm working with a group right now. We're trying to flip the culture of this senior living company. And we found out that the time when they're most active, these residents, is, uh, is at night when the activity coordinator isn't there, and they're creating all their card games and different things. It's like, okay, no one's watching.

Um, so, you know, we titled this session Aging in Place versus Senior Housing, and, you know, the main thing there is what you just hit on, is that I think the stat now is that adults spend 10 hours a day on screens. We're more isolated and lonely as just population regardless of seniors. And I guess it's only— I guess it's trending. It's maybe only going to get worse, unfortunately. So when I mentioned that to you, I'm like, look, it's a bit of a clickbait title for a session. But I mean, you said it perfectly. It really doesn't matter. It matters to each individual, meaning that aging in place could be right for the right person at that right place in their life. But at some point, I've guessed senior housing. But what is your overall thought if we said, what is the value proposition? For senior housing? Outside of a needs-based.

Yeah, outside the needs-based. I think it, but even that, you know, there's elements there. I think it starts with this fundamental empathy that we all should have because we've gone through different transitions and stages in our life of what do I want the next chapter to look like? And in that thinking, it's not about aging in place and how it's evil. It's not about senior living and how it's evil, or, you know, both are amazing. It's— it has a personal context in all of this. And so I have in my book, I have a, a chapter where I rant on aging in place, the term. I hate the term. It seems like you're static, which is totally not what is, is the research on healthy longevity. And as a strategy, I think it's awful because it's presupposes that typically where you live in this, I'll call it, two-story suburban home built in the '50s is the best place for you at every stage in life. And what I found, and I'll share some data here in a moment, what I found is that there may be an emotional connection, there may be a fear for change, but those same people may lack purpose, they may be socially disconnected, But that doesn't necessarily mean that they're running to senior living, particularly if senior living doesn't speak their language. Like, as I mentioned earlier, this idea of like finding my here, not saying I have to move over there. And when we have to— when we're in a position where it's like, oh my gosh, I have to move over there, I have to— like, the market is dramatically smaller, and that's not an enthusiastic resident, citizen, however you want to talk about them.

Okay, so you, you just hit on talking about your data. So you obviously did a survey, and can you share kind of—

yeah, so when I wrote this book, and again, the main theme is it's about right place at the right time and being thoughtful, because it is— when you look at the impact of purpose, social connection, physical well-being, financial well-being, and then just the physical, emotional, and psychological elements of place, where you put yourself is such a driver in your lived experience. So I write this book and then having no idea what's gonna happen and what I found, one of the things that came out of it is there was an assessment in the book that people found really valuable because they could apply it to their life. And they said, a few readers were like, just put that online. I said, okay, readers say, give the readers what they want. So I put the, it's called the Right Place, Right Time assessment, put it online, it's just a couple minutes. And it's been fascinating, Michael, because what's happened is it's allowed people with very little friction to go in and broaden this sense of place and get some feedback on it, like where they are, a little bar chart, and then they get some advice. And people have taken it, about 3,000 at this point, really across the country, across the world, people from India, I got a group in England right now that wants to do a British version. I guess you say words like bloke or something like that. So this is not— when I raise this issue about finding your place, it's not necessarily an older thing, an older person thing. It's not necessarily a US thing. It's a global thing. It's across the age spectrum. And the bulk of people have responded in their 60s. But people younger and so on, it's been interesting. People in their 60s just saying, God, what do I do? What do I want my life to look like? And two of the main takeaways is the majority of the people have an opportunity for greater purpose by their own acknowledgement, by a set of questions in these particular cohorts, but it's really evident everywhere. And at the same time, you know, it's have an opportunity for greater social connection as well. So when people are often coming in, you know, to your communities, there's a lot they're bringing in. Yeah, they don't necessarily share a lot of that, particularly if we don't ask the set of open-ended questions to bring it out. And there's a level of probably distrust if every answer leads to— every question leads to the answer of moving into my community. One of the benefits of this assessment is I've actually had a number of providers curious about it. Could you customize it, use it in some fashion? Because it doesn't have a bias. It's not saying all roads lead to senior living, but what it does do, and I think this is an important part of this, ultimately, I believe if people are more thoughtful about this decision at each stage in their life, including the senior living one, you're more likely to, A, have people that see the benefit of your community, if in fact your community offers what kind of where they are, And when they move in, it's an enthusiastic yes. I did my work. This is what I want. This is the right time. And so I think there's things that can be done along the journey to prep people for this and then also maybe be more happy when they're there.

Yeah. You know, I'm looking at that. I think you should open a community and call it Here. I mean, that branding and everything looks pretty slick.

Yeah, thank you.

So you do consulting work as well. So, you know, what are the certain things that you currently, you know, when you're advising, operators that you're helping them with now these days?

Well, I mean, it's a really busy time right now because you've got— when the pandemic hit, of course, people are— they got to jump in and make sure that there is an epidemic in their building. But I think what happened coming out of that, or even some cases during that, was this recognition that there are just huge issues and opportunities companies to be more relevant. And talked about some of that earlier in the context of universities. So I think strategy is no longer something we kind of do. Like, you need to be doing it all the time. And this world of, of, of, of being in flux where, you know, of course thinking back to yesterday's conversation about AI and where things are headed, we, we no longer are in a place where we have these set of assumptions that are fixed that can drive our decision-making over the next 5, 10, 15— it's not how the world works. So I have part of what I do, uh, it's McKinsey-ish, you know, coming along CEOs, executive teams, and their boards, really thinking through how do you thrive as an organization, uh, you know, in the future. And some of it, Michael, comes back to some of the principles we're talking about. Like, you can't— one of the criticisms I would have from yesterday's CEO panel, I think there was this implicit assumption, this demographic assumption that said, we've got these boomers coming, we've talked about it for a long time, the boomers haven't hit yet, at least based on ages for people moving in. But we just can't assume that we get the same capture rate of people living longer. Like, we have to work hard to earn that capture rate. So that means that just doing things the way we've been doing them, as we all know, is not inherently the right thing. But also, you just may not get those same results you had in the past. I was— it was a great discussion, but I wish we'd spent a little more time talking about the revenue side of things, around how do we create environments which really draw people in because the end of the day, if you have 100% occupancy and you have a waiting list, that makes the labor problem a lot easier to deal with. You know, that makes your capital problem a lot easier to deal with. So I think there— we're at this point right now, Michael, where I think that there's opportunities for any size organization to be more thoughtful about the strategy, but then also like really put into practice.

So are there any operators that you think are doing, are doing a good job? Do you want to say publicly here on camera?

Yeah, I get myself in trouble.

Who's doing a really bad job?

Yeah, no one here. No one here. If you came here, this is on the step to recovery. Yeah. Uh, no, I, I think it's really hard. I do. I think this one of the themes I think people should be walking away with is one that you live every day which is it's a really complex business. And by the way, aging, successfully aging, healthy longevity is very complex. Like, there's just a lot of variables at work. So the key thing, I believe, is not to run away from the complexity, but make sure you get to the other side of complexity where it just works, people get it. So I would say at the moment we're in flux. I honestly, I can't I can't point to an organization right now that I would say, I know there's some great leaders, friends of mine that are great leaders, but I can't say that I can point confidently knowing truly what's happening within the communities that they've arrived. I think there are some that have vision. I think there's some that are in that process, but at the end of the day, it's did it deliver? And I think it's too early.

[Speaker] Well, there's also some element, I guess, that also it's not easy, and this is a challenge I think overall at the Innovation Forum, because we like to talk about that, but we know that the operators are dealing with a lot of pressure. You may meet with a lot of companies that could have innovative solutions to do that, but you may not have the budget, or you're dealing with really tight margins, and I think a lot of that also plays into really strategizing and rethinking kind of what the value proposition is.

Oh, sorry, one quick thing I was gonna say. Part of the discussion yesterday was around bigger being better, potentially. I think one of the challenges when you get bigger, whether you're vertical or horizontal, going back to that discussion, there's just— it's hard to be nimble when you get big. And, and also, by the way, this is a lost point that came up yesterday too, and that is we're going to go into segmentation, we're going to know our customer better, we're going to deliver that. When you segment, your market gets smaller. So if you're going to segment and have a brand around a certain segmentation, you better nail that segment. Yeah, because if you don't, like, that— you've cut off a key piece of your, your marketing. So anyway, I just— I think there's, there's elements to also consider in that area. Yeah.

Do you have any questions or any thoughts? I mean, you know, we're having this conversation about— Ron?

Yeah, I, I like, I like the way you brought up the issue of words mean something. And something that's bothered me for a long time is what we call ourselves as operators.

Yeah.

Operate, what do you operate?

Yeah, yeah, that's a great point.

You know, there's nothing in our rest of society that you operate other than surgery that has a human component to it. I think what you're really saying, if I'm reading between the lines, is that community is one of our major products.

It can and should be, and that's why, like, I believe that This, the opportunity for impact, this is why I got involved in this industry 20 years ago. It has enormous opportunity for societal positive impact. Intergenerational, as pointed earlier, like otherwise, but you are so much more than an operator. You, ideally, margins are tight, but ideally people should have like a psychologist on staff. Like, you should have experts around, like, friendship building. Every 7 years, researches indicate that your social network, half of it gets flipped. As you get older, you know, people pass, things happen, your social networks get smaller. It takes courage to go out there and put yourself out to make new friends because they may not reciprocate. So there are huge— you're right on— there are huge elements of community building, of empowering people around what does it look like to have this, this, this life worth living. You know, you're going to see this more and more. You're going to have more stories about, you know, euthanasia with people getting older and like the morality around that. What gets lost in some of that is it's as a society, we're not having enough conversations about what is it— look, there's something called the U-shaped happiness curve where I do a blog every other week on the HERE website. It's trying to really push how we think about this more broadly, and one of them was on this U-shaped happiness curve. And what it is, you're certain happiness in your 20s, and then you kind of go through this precipitous decline to your like late 40s, around 50. I like to think it has something to do with teenagers. We got 3 in the house right now. And then, then you go, you loop back up, you start to have this positive trajectory. And then your 70s and 80s, your, your, your well— your happiness, your self-reported well-being is greater than it's ever been in your life. Now there's some selection bias, not everyone lives that long. But for people that— this is a global phenomenon, it's not just a US thing. So I think, I think operators is a disservice. I think providers also is too limited. Like your ability to create, not necessarily impose, this sense of community, opportunities for belonging. Like our society is thirsting for this. And this is not just a senior living thing. This is a real estate developer of any sort. And by the way, this type of thinking also bleeds in, it spills over, you know, to your employees. Like, they're craving for this sense of belonging too. So you're totally right that there's an opportunity, maybe a future panel, like, what terms should we— we started with attainability, where do we go from there?

Well, and that's a good observation because even, you know, obviously I'm from outside the industry, but we say providers sometimes, or operators, but provider is also— it's providing, you know, especially if you're in the more on the care side, provider may sound right. But, uh, we should come up with a whole new, uh,— set of words to use. Ryan, you actually— I just want to have one more thing. You put out a pretty insightful blog post the other day about your experience going to Whole Foods. And I actually cross-posted that blog post because we do a retail event. We bring all the retailers together and restaurant chains. Then for them, it's all about how do we elevate the customer experience inside the store. And you went to the Whole Foods here, which is the original one, and you talked about how you drove in. You parked your car, you went, you picked up your food, and you didn't interact with anybody because it was self-checkout and that. So in life in general, we're kind of getting to this, you know, a lot of these times we would even have social interaction outside that you're not having that. So I think that there's more there for the operators, the providers, or what are we going to say, people in the senior living business.

Well, so I just want, just to finish on that point, you know, Anne had a slide earlier, design matters. And there's, there's physical design, but there's also operational design. And there's going to be— oh yeah, there's going to be an experience. There's going to be a lot of pressure to streamline operations, to find out where ChatGPT can get in there, or whatever the different things are. I believe you all, the leaders here, when you have these different decisions, it can't be made exclusively by the CFO. You have to say, what is the trade-off of this particular decision? And yeah, what happened was, I was at this Whole Foods, and literally, just like Michael described, I went in, got my parking sticker, ticket, go up, did my shopping, went through the self-checkout because that was really seen the best thing. I got my ticket validated, I left. I didn't talk to anyone. I could have not made eye contact with anyone if I wanted. Okay, it's not just this Whole Foods. I was in Cincinnati and Kroger's there. They— it's so depressing. This is like 9 o'clock at night. They have 12 different stations. The only ones that were offered were the self-checkout ones, and they've taken another level. Their self-checkout ones, they have the conveyor belt. So imagine you're single, you're not living with anyone, you're not interacting with people as much as you like, and then you have this generally depressing grocery shopping visit to begin with, and then you go in and you're like, "Here's my milk and my cans," and they just roll down the conveyor belt and they start to pile up. I mean, we saw this pile up, and then you do this for a while, and then you pay, and then you take your 4 steps, And then you're bagging all this stuff. I mean, it's— this is not made— this is happening now. So I— closing thought, kind of an emotional thing for me. So I hired my daughter to edit my book and then my blog, and now I have my middle school—

And I hired his daughter to watch my kids.

Yeah. So she's a good writer. I think she'll have a book that she'll write at some point in her life. But part of it, I knew she'd do a good job, but I wanted to expose her to these ideas around social connection and belonging. And so she won a scholarship on Sunday night. She's part of this choir, which is, we go to a local high school, it's a big high school, they have a really large choir department. And they put some excerpts of what her application was when she won this award. And she's like, you know, I loved singing. I love how I got challenged to perform. But for me, it was about community. You know, that's, that's what, that's what, that's made the biggest impact. And that's why I want to sing in college. I want to have that community. So there's an element for all of us leaders, you know, you got to design with this in mind, but also individuals, we need to have agency and recognize this matters. Yeah.

Well, we're out of time, but thank you, Ryan. Thank you.