The Future of Senior Living: Discussion with Bob Kramer

A conversation with one of senior living’s most influential and high-profile thought leaders and connectors With over 35 years of industry leadership, Bob has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly.  

Bob Kramer 

• Founder, Nexus Insights https://www.nexusinsights.net/
• Co-founder, Strategic Advisor & former CEO, NIC https://www.nic.org/

Listen on your favorite podcast platform

Full Transcript of the Discussion

Special Thanks to Our Positive Aging Community Champions featured on this discussion:

• Phil Golden of Springwell Senior Living Community
• Ellen Platt of The Option Group and a Contestant in the 2023 Baltimore Memory Ball Dancing Stars 

Questions Asked

• "how is senior housing is affortable how people with limited income can afford."
• So much research focuses on what older adults will Want; what about what so many older adults will be able to afford, especially with the skyrocketing costs of senior living, assisted living, and memory care?
• "Sadly, most of the faith based senior missions have become unsustainabable.  
• I love this conversation b/c most of us simply want safe, kind affordable care …. Granite, drapery and hotel like settings come at the cost of dedicated care staffing. Many DC CCRCs are lacking RN staffing but they have luxury lobbies…The boomers will not be fooled"
• How about working to convince the federal astate governments to help the middle income market to be able to afford assisted living by picking up the portion of the cost they cannot afford. It may be reimbursing communities 100% of the cost for services for low-income residents; 50% to 80% of the cost for middle income residents?
• Builders today have changed the makeup of Senior Housing.  They are putting so many aminities in the homes and out pricing Seniors.  We need a builder to build more affordable housing for Seniors with the aminities needed like wider entries, less stairs, hand rails and accessable appliances.
• One idea we have is to have collage students live at the community (vetted and background checked) in return for serving as part time staff in the community. Built in intergenerational living. I know it’s done in Europe, but do you have examples of this in the US?
• "I feel that changing the revenue model for the communities will help to offer more for less cost to the seniors.
• The residents have a lot to offer toward making the communities more affordable by offering their skills and services  while feeling like they still have worth and purpose.
• I second that! My parents are still in Germany and the landscape is changing!
• thank you great discussion

Chat Transcript

12:12:02     From  Felice Mitchell   to   Hosts and panelists : Felice Mitchell, MBA, MSW (Marylander)- Terrapin & Bison, Helping Dad care for Mom with Alzheimers in NC

12:12:13     From  Felice Mitchell   to   Hosts and panelists : Please add me to mailing list

12:14:35     From  Steve Gurney - ProAging Community : The National Investment Center for Seniors Housing & Care https://www.nic.org/

12:15:28     From  Steve Gurney - ProAging Community : https://www.nexusinsights.net/

12:18:57     From  Ellen Torres, Alzheimer's Association   to   Felice Mitchell and all panelists : Hi Felice.  You can access information from the Alzheimer's Association at www.alz.org and sign up to receive our weekly enewsletter through the website.  No matter where in the country you live, there is a local chapter able to help you.

12:23:08     From  Ellen Platt - The Option Group   to   Felice Mitchell and all panelists : You can sign up for newsletters from The Option Group regarding case management, placement and advocacy at www.theoptiongroup.net

12:23:27     From  Steve Gurney - ProAging Community : Ellen Torres, Alzheimer's Association to Felice Mitchell, All Panelists 12:18 PM

Hi Felice.  You can access information from the Alzheimer's Association at www.alz.org and sign up to receive our weekly enewsletter through the website.  No matter where in the country you live, there is a local chapter able to help you.

Ellen Platt - The Option Group to Felice Mitchell, All Panelists 12:23 PM

placement and advocacy at www.theoptiongroup.net

12:24:36     From  Jim Sanders : Senior housing is only 12-15% of the potential market. Why not empower aging in place and hospital at home rather than preserve broken business model. Staffing and high cost will also limit scale.

12:24:50     From  Dana Bradley : Hi Bob (and Steve),  A shoutout of gratitude for your work which inspires each of us across the industries...   Having seen you both in action --- Could you share how interacting with students (of all ages) inspires and informs?   Thank you, Dana

12:26:33     From  ESTHER GREENHOUSE : Senior Care has typically provided “prosthetic” environments, which sadly contribute to the preventable physical and cognitive decline of those they serve.  In the reset, the focus must be to enable independence and for residents (and staff) to THRIVE.

12:27:48     From  ESTHER GREENHOUSE : @Jim Sanders:  great question.  A huge barrier is that our housing is not designed to support successful aging in place and in-home care.

12:28:20     From  Gloria Gaddy : Where have you been ??? I've been shouting all of this for the past 25 years, I am in the hot seat  !  Help is on the way, how can I join with you in the fight ?  Gloria Gaddy - Bowie Senior Center

12:28:22     From  Felice Mitchell   to   Hosts and panelists : Bob, i agree and have experienced ALL that you have stated! I am actively transitioning my career into commercial real estate through ULI.  I desire to focus on CRE in the Senior Living Space. Seeking a professional opportunity to serve in a strategic planning, technological, change management capacity, with a mindful development organization.  Affordability is an issue as downsizing becomes necessary. Are NMTC and LIHTC part of the solutions/?

12:28:34     From  Steve Gurney - ProAging Community : The Forgotten Middle: Housing and Care Options for Middle-Income Seniors in 2033  https://www.norc.org/Research/Projects/Pages/forgotten-middle-housing-and-care-options-for-middle-income-seniors-in-2033.aspx

12:29:05     From  Alice Fisher   to   Hosts and panelists : OutstandingLife is a no charge senior center for LGBTQA+ older adults.  We are almost totally open

12:29:17     From  Felice Mitchell   to   Hosts and panelists : Adaptive Reuse

12:30:25     From  Lesley Hatch   to   Hosts and panelists : Right. But it’s not profitable for workers to drive places and bill only 1/2 hr or 1 hr. Especially given they are such an exploited labor group

12:32:35     From  ESTHER GREENHOUSE : It’s warehousing of elders

12:33:04     From  Felice Mitchell   to   Hosts and panelists : Yes, yes, and yes!!!

12:33:17     From  Tiffany Benton   to   Hosts and panelists : I love what’s happening in Germany. Farms that no longer can survive on farming practices are being reimagined to house seniors to be part of the farm. The owners in these mini communities are the original owners, and some of the “staff” are different generations of individuals (not necessarily in the senior care industry) that help on the farm with daily chores. BUT, most importantly, each senior takes part in the chores and activities!!!

12:33:31     From  Renee Dunham   to   Hosts and panelists : How does the Kendal Corporation live up to your exciting ideal future for seniors?

12:33:42     From  Steve Gurney - ProAging Community : Sustainability in Senior Living https://www.retirementlivingsourcebook.com/videos/sustainability-in-senior-living

12:33:55     From  Tiffany Benton   to   Hosts and panelists : You’re saying what I’m working on implementing at our community, but my question is, how do we respond to people saying it’s taking advantage of the seniors?

12:34:11     From  ESTHER GREENHOUSE : “Learned Helplessness” is caused by prosthetic built environments and protocol of care

12:34:45     From  Tiffany Benton   to   Hosts and panelists : I believe it gives purpose, and what about discounting the living cost for services rendered y the residents?

12:36:22     From  Tiffany Benton   to   Hosts and panelists : We want to become an Eden Alternative community so the team AND Residents become part of building the culture and operations of the community!

12:37:19     From  Steve Gurney - ProAging Community : Welcoming Immigrants &

Solving Staffing Crises https://goodwinliving.org/about-us/citizenship/

12:37:44     From  Natalie Doyle : This reminds me of the Quaker model (Kendal residences, Collington-Kendal in near Bowie) where residents have a say in major decisions).

12:38:36     From  Jim Sanders : Health improvement is biggest issue and cost  for 100 year longevity model. Discussion today is building out from current facility based business model. Better to start with clients and moving back to what is needed is portfolio of staged services. This may home of multiple housing.

12:38:51     From  ESTHER GREENHOUSE : That is huge and crucial:  we currently have 7 potential caregivers for every one older adult.  That will change to only 3 potential staff for every one 1 older adult.  We must support immigrants who can provide that care.

12:38:56     From  Sue Winter Hallman : One time I heard of a community in PA that built a development with housing for young families, and townhomes and apts. houses and playgrounds, parks  and shopping nearby and those who need more comfortable Senior living and neighbors help. Are there any builders  doing this in this country?

12:39:37     From  Steve Gurney - ProAging Community : Community Trumps Amenities!  I love that phrase!

12:39:38     From  Carla Andersen : Great discussion. Agree with Bob's observations and perspectives on all. The empty buildings may function dually as a care home and a training school for those inclined to assist elders to find joy and purpose, as well as with personal care. All communities will need health aides to address loss of independence in the populace.

12:39:58     From  Lesley Hatch   to   Hosts and panelists : That is the way Montessori memory care works. It’s very successful but few places do it

12:41:04     From  Jacquelyn Kung   to   Hosts and panelists : Amen, Bob! Thanks for your leadership in bringing the industry forward.

12:41:35     From  ESTHER GREENHOUSE : Bob has been a guest with the Cornell Institute for Healthy Futures.  For professionals—join us for the Reinventing Health, Hospitality, and Design Symposium https://ihf.cornell.edu/events/symposium-reinventing/ in May at Cornell University.

12:41:38     From  Lesley Hatch   to   Hosts and panelists : As for indépendant living- all of this is great except 18% are developing or have mild cognitive impairment, most to develop dementia. They can’t function enough to join clubs, volunteer, etc. They are left out of these discussions over and over again, and the entire burden of care is left to the sandwich generation.

12:41:44     From  Renee Dunham   to   Hosts and panelists : where is the community in Vermont that Bob Kramer mentioned?

12:42:11     From  Sue Winter Hallman : who do we reach out to in our community...Builders, Chamber of Commerce, who??? Who from Nexus is a speaker that travel to speak about about this to a captive Senior audience?

12:42:23     From  Tiffany Benton   to   Hosts and panelists : Our goal is be a National Wildlife Certified Community, as well as create our own industry to fund our programming and lifestyle projects. Sustainability is high on the list and my goal is to become a B certified community!

12:43:17     From  Felice Mitchell : Yes, Steve and Bob, social systems are unequivocally key. Housing solutions addressing the social needs for both the marital /partner caregivers and Alzheimer patients.

12:43:18     From  Lesley Hatch   to   Hosts and panelists : It’s lovely- and the most expensive one I have visited in new England!

12:43:44     From  Steve Gurney - ProAging Community : Ingleside https://inglesideonline.org/

12:44:22     From  Steve Gurney - ProAging Community : Welcome to Wake Robin,

Vermont’s first Life Plan Community https://www.wakerobin.com/

12:44:26     From  Lesley Hatch   to   Hosts and panelists : Right but actually most of the family caregivers aren’t spouses but children. And Aging in Place = moving mom in with your 2 kids, your job, your husband, and then having to cut back work, quit, etc. it’s a fallacy that this works.

12:44:36     From  Lesley Hatch   to   Hosts and panelists : But it’s free to the government for the most part so it’s the buzz word

12:45:45     From  Steve Gurney - ProAging Community : Where You Live Matters https://www.here.life/

12:46:17     From  Steve Gurney - ProAging Community : Stage (Not Age): How to Understand and Serve People Over 60--the Fastest Growing, Most Dynamic Market in the World https://a.co/d/03zAiGr

12:47:01     From  Renee Dunham   to   Hosts and panelists : I live in a large diverse apartment building with many seniors.  With whom can we discuss how to organize ourselves to serve our aging selves and others (such as tutoring children, action for climate,  helping health workers, etc.)?

12:47:51     From  ESTHER GREENHOUSE : Article:  “Aging in Place is Not the Answer.”  I will be a guest here with Steve on April 20th  https://www.linkedin.com/pulse/aging-place-answer-esther-greenhouse-m-s-caps/

12:48:02     From  Steve Gurney - ProAging Community : Building Your Personal "Village" https://www.retirementlivingsourcebook.com/events/building-your-personal-village-for-your-solo-aging-plan

12:49:34     From  Steve Gurney - ProAging Community : From Alice Fisher to All Panelists 12:29 PM

OutstandingLife is a no charge senior center for LGBTQA+ older adults.  We are almost totally open

12:50:10     From  ESTHER GREENHOUSE : Check out this fascinating model for Aging in Place:  remodel with enabling design, create a rentable unit, and provide management of the rental.  Win:Win for older adults and direct care workers https://www.aarpinternational.org/resources/equity-by-design/principles-in-action#ava

12:50:12     From  Steve Gurney - ProAging Community : From Felice Mitchell to Everyone 12:43 PM

Yes, Steve and Bob, social systems are unequivocally key. Housing solutions addressing the social needs for both the marital /partner caregivers and Alzheimer patients.

12:50:12     From  Louis Tenenbaum : Louis Tenenbaum here.  Bob,  what is the alternative? We do not have nor can do we have time or money to build new and better housing for all.    We can do a better job housing older citizens if we help them plan and make their homes safer.  It will save money in the long run.

12:50:37     From  ESTHER GREENHOUSE : Great to see you here Louis

12:51:13     From  Catherine Twitmyer   to   Hosts and panelists : Would love to see intergenerational communities with an option for care for those who need it!

12:51:37     From  ESTHER GREENHOUSE : Check out @Louis Tenenbaum’s crucial work to make successful aging in place a reality—and you can get involved https://www.homesrenewed.org/

12:51:41     From  Lesley Hatch   to   Hosts and panelists : It’s a natural resistance to confronting one’s demise that keeps people from planning adequately for this period of life

12:52:55     From  Louis Tenenbaum : Thanks, Esther, Good to see you here, too.

12:53:40     From  Lesley Hatch   to   Hosts and panelists : There are major lawsuits all over the country in buildings like this where they are trying to force elders out who have MCI or dementia. These are members of a disabled populations so the lawsuits are bitter. But these people don’t have children, or those who can’t or won’t take care of them, and they can’t plan anything by this point.

12:54:00     From  Steve Gurney - ProAging Community : Program of All-Inclusive Care for the Elderly (PACE) https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/PACE/PACE

12:54:03     From  Lesley Hatch   to   Hosts and panelists : PACE requires medicaid in MA

12:54:53     From  Lesley Hatch   to   Hosts and panelists : If you make $100 above the medicaid line in poorer states such as Alabama, you have no help at all. No where to live and no way to get help.

12:55:04     From  Lesley Hatch   to   Hosts and panelists : YES!!!!

12:55:13     From  Lesley Hatch   to   Hosts and panelists : But that requires legislative action

12:55:28     From  ESTHER GREENHOUSE : To answer @Renee’s question:  some municipalities provide a caseworker in the building.  Another great model is for at least 3 Medicaid elders to share a caregiver:  8 hr shifts x 3 = 24 hours of care.

12:56:02     From  Steve Gurney - ProAging Community : And What if I Need Long Term Care? Discussion with Joanne Lynn, MD  https://www.retirementlivingsourcebook.com/events/and-what-if-i-need-long-term-care-discussion-with-joanne-lynn-md

12:56:25     From  Lesley Hatch   to   Hosts and panelists : How do you do this when your friends have died, and you have no children?

12:57:26     From  Randy Schellenberg   to   Hosts and panelists : Steve, I do not know if this is appropriate to send to all attendees.  I will forward this to panelist only at this time.   I appreciate the emphasis on treating front line care workers as problem solvers.  Truly front line care workers want to be part of the solution.  One of the challenge requires us to reduce the physical expectations we have of caregivers.  Way to often staff feel like "hired muscle" than a giver of care.  This link might be helpful?  https://vimeo.com/803195224

12:57:41     From  Heidi Garvis : What an excellent conversation!  We offer older adults a personalized planning session for housing and care.  We help preserve quality of life! www.CaringConsiderations.com  571-488-9396

12:58:37     From  Steve Gurney - ProAging Community : this is a great comment!  I appreciate the emphasis on treating front line care workers as problem solvers.  Truly front line care workers want to be part of the solution.  One of the challenge requires us to reduce the physical expectations we have of caregivers.  Way to often staff feel like "hired muscle" than a giver of care.  This link might be helpful?  https://vimeo.com/803195224

12:59:28     From  Steve Gurney - ProAging Community : The Forgotten Middle: Housing and Care Options for Middle-Income Seniors in 2033 https://www.norc.org/Research/Projects/Pages/forgotten-middle-housing-and-care-options-for-middle-income-seniors-in-2033.aspx

12:59:57     From  wida nawabi   to   Hosts and panelists : We have commercial insurances and Medicare Part C originally registered for home care services but along the way dropped or member services interchangeably using home care services vs vs home health care coverage offered to the elderly and assuring claim coverage, placing providers in a bind.

13:00:31     From  Steve Gurney - ProAging Community : From wida nawabi

We have commercial insurances and Medicare Part C originally registered for home care services but along the way dropped or member services interchangeably using home care services vs vs home health care coverage offered to the elderly and assuring claim coverage, placing providers in a bind.

13:00:51     From  Dixcy Bosley   to   Hosts and panelists : Bob Kramer is a prophetic voice bringing light to a very dark reality.  I am feeling Easter joy about every word of this vision of a more just society . So grateful and inspired.

13:01:45     From  Felice Mitchell   to   Hosts and panelists : Steve, and Panelists, thank you for this very timely conversation. Will you provide a copy of this chat with the live links attached?

13:02:21     From  Steve Gurney - ProAging Community : all chat and recording and podcast will be available this afternoon at www.proaging.com

13:02:22     From  Lesley Hatch   to   Hosts and panelists : Oh! AgeTech! What was the name of this?

13:02:45     From  Sheila Bassoppo-Moyo : Have we started?

13:03:23     From  Steve Gurney - ProAging Community : Age Tech Atlanta https://asaging.org/on-aging-events

13:05:47     From  Rick Banas : We have to change the culture from "It is All About the Children."

13:05:48     From  Steve Gurney - ProAging Community : Builders today have changed the makeup of Senior Housing.  They are putting so many aminities in the homes and out pricing Seniors.  We need a builder to build more affordable housing for Seniors with the aminities needed like wider entries, less stairs, hand rails and accessable appliances.

Lillyn Bennett 12:47 PM 

Are there any investors willing to look at establishing a more affordable Senior Tiny Home Community?

Lesley Hatch 01:01 PM 

I love this too! GREAT idea!

13:06:04     From  Steve Gurney - ProAging Community : Tiffany Benton 12:53 PM 

One idea we have is to have collage students live at the community (vetted and background checked) in return for serving as part time staff in the community. Built in intergenerational living. I know it’s done in Europe, but do you have examples of this in the US?

Lesley Hatch 12:57 PM 

nice idea! europe is way ahead of us especially in memory care

Steve Gurney - ProAging Community (You) 01:05 PM 

RESIDENCE PROGRAM https://peabody.jhu.edu/life-at-peabody/career-services/opportunities/community-based-learning/musician-in-residence-program/

13:06:49     From  Hugh Reese   to   Hosts and panelists : Thanks for this. One of your best, Steve.

13:07:42     From  ESTHER GREENHOUSE : Check out Wheelpad for accessible tiny homes and additions https://www.wheelpad.com/

13:07:43     From  Ruth DeHart   to   Hosts and panelists : Bob, you are an inspiration.  Look forward to following your work. I agree totally, we must Age- in Place the Right Way. Ruth

13:08:03     From  Steve Gurney - ProAging Community : From Ruth DeHart to All Panelists 01:07 PM

Bob, you are an inspiration.  Look forward to following your work. I agree totally, we must Age- in Place the Right Way. Ruth

13:08:04     From  Madhu Mehta   to   Hosts and panelists : I love the discussion Bob just hit the nail I am a voleenter

13:08:44     From  Madhu Mehta   to   Hosts and panelists : For senior organization in Portland OR

13:10:04     From  Carla Andersen : Community development is the only solution to caring for humans from the womb to the tomb. It takes a village.

13:10:28     From  Felice Mitchell : I agree with everything that has been shared today. A critical opportunity is to normalize Strategic Aging Plans, as we move forward.

13:11:09     From  Dixcy Bosley   to   Hosts and panelists : George Fox University in Newburg OR has college/ senior housing. Quakers!!

13:12:37     From  Rick Banas : Illinois has an excellent program that uses a private/public sector model to provide affordable assisted living that serves the low-income market.

13:13:32     From  Lesley Hatch   to   Hosts and panelists : Thank you so much!!!

13:13:41     From  ESTHER GREENHOUSE : Crucial & fascinating discussion.  Much work to be done…thank you Bob for your leadership.

13:13:43     From  Rick Banas : Illinois in July of 2022 increased the reimbursement rates significantly.

13:13:45     From  Catherine Twitmyer   to   Hosts and panelists : Thank you for this discussion.  Really valuable.

13:14:00     From  Tiffany Benton   to   Hosts and panelists : Thank you so much for the fantastic discussion today!

13:14:18     From  Catherine Freedberg   to   Hosts and panelists : BRAVO and thank you!!

13:15:18     From  Felice Mitchell : Yes, Carla and Rick, Public/Private strategic partnerships are key. I am a new Bob & Steve fan and will be following you both closely!

13:15:25     From  Lesley Hatch   to   Hosts and panelists : Loan repayment!!!! Wow!

13:15:51     From  Natalie Doyle : Thanks so much for this!

13:16:06     From  Lesley Hatch   to   Hosts and panelists : I think a possible starting point is a federal elder protection law

13:16:15     From  ESTHER GREENHOUSE : Thanks @Steve for not cutting off the discussion at 1, this was great.

13:16:16     From  Carly Powell : This was an amazing conversation, I appreciate that I was able to listen in. Can't wait to share the recording with my parents and brothers!

13:17:17     From  Tiffany Benton   to   Hosts and panelists : Yes, sharing this with my team!

13:17:26     From  Sue Winter Hallman : Can there be a conference to invite all who are interested to come to with new models for us?