INSPIRE PASSION. LEAD CHANGE.ALFA 2014 CONFERENCE & EXPO TAKEAWAY PUBLISH DATE: JUNE 2014

ALFA 2014 Conference & Expo

INSPIRES PASSIONAttendees learned about new services, environments, technologies, research, and best practices in Phoenix.

ALFA offers key takeaways from some of the most well-attended education sessions at the ALFA 2014 Conference & Expo.

Each of the 2,250-plus senior living executives who recently attended the ALFA 2014 Conference &

Expo in Phoenix were greeted by a pair of positively pithy phrases—“inspire passion” and “lead change”—whenever they pulled out their densely packed programs.

Both were appropriate given the four-day event’s rich lineup of speakers and content, all aimed at educating attendees about the trends shaping the senior living business as it evolves and advances.

ALFA Board of Directors Chair and Brandywine Senior Living CEO Brenda Bacon, mentioned

that evolution during the conference’s opening general session when she told the audience, “so many things are changing in this industry—and for the better.” General Stan McChrystal followed up Bacon’s comments by sharing advice related to making a difference in an environment that’s changing rapidly, which certainly describes the senior housing space. “You have to learn to adapt organically,” said the four-star general, former commander of U.S. and international forces in Afghanistan and former leader of Joint Special Operations Command, which oversees some of the military’s most sensitive forces. “It has to be a part of your DNA,” he added, especially since “the rate of change is outpacing organizations’ ability to adapt to that change.” And if you can’t adapt? “You’ll fail,” said the author of the best-selling leadership book, My Share of the Task.

2014 CONFERENCE HIGHLIGHTS:• The second day’s general session featured author and speaker Sir Ken Robinson Ph.D. tackling the phrases “inspire passion” and “lead change” and arguing that it isn’t natural talent that drives personal success, but rather a delicate interplay of talent, passion, attitude, and opportunity that brings people to achieve their highest levels of success and lead lives of both meaning and purpose.

Astronaut Mark Kelly and his wife Rep. Gabby Giffords, spoke of perseverance and the importance of caregivers, while honoring the 2014 HERO AWARD WINNERS.

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• Later that same day, astronaut, retired U.S. Navy captain, naval aviator who flew combat missions during the Gulf War, and best-selling author Captain Mark Kelly and former Rep. Gabrielle Giffords, the accomplished lawmaker who drew international attention following her attempted assassination in 2011, helped honor and celebrate the achievements of the 2014 ALFA Hero Awards recipients.

• During her keynote speech on the final day of the conference, diversity and marketing segmentation expert Kelly McDonald offered insight on how senior living communities can be “culturally ready employers.” Diversity comes in many forms and the United States is no longer a “melting pot” of cultures but a “salad bowl” where all the ingredients are distinguishable. Today, one in three U.S. residents is non-white and one in six is Latino. Workplaces should be knowledgeable about the Latino culture. She also recommends good employers follow the five Rs: Respect, Recognition, Reward, Respond, and Reflect culture and tradition.

In addition, the ALFA 2014 Conference & Expo’s many core education sessions touched on critical topics for today’s senior living executives, including:

• John DiMaggio, CEO of Blue Orange Compliance, and Cliff Mull, a partner in Benesch Law’s Healthcare Practice, offered insights on the current state of the Health Insurance Portability and Accountability Act (HIPAA), including discussions regarding which senior housing providers must comply, risk assessment, enforcement and audit preparation,

and the most recent modifications to the law.

• Five senior living CEOs shared “insights from the executive suite” in another session, which also featured ample discussion on the future of the industry, including new opportunities and potential challenges faced by providers.

• A quartet of New Perspective Senior Living’s executives offered advice on how companies can enhance engagement in their communities by focusing on the four “pillars” of physical fitness, brain fitness, the dining experience, and social and spiritual enrichment.

One of their many morsels of advice: “The key to brain fitness in the older population is challenging the brain,” said Holly Osters, New Perspective’s director of memory care programming. “It’s not just about ‘using’ it.”

• The Affordable Care Act and accountable care organizations served as the centerpiece of Anne Ellett’s session, titled “The Use of Clinical Outcomes to Partner with Accountable Care Organizations.” A senior clinical specialist at Silverado, Ellett walked attendees through how they can collect clinical data and then properly present it to potential ACO partners.

quickc l i ckAccess session summaries, presentations, audio recordings, videos and more at alfa.org/2014conference

Executives Look Ahead,Share Lessons Learned

CEOs Share Their Career Journeys

Experienced Assisted Living Providers Share Secrets Of Success

Crafting The Customer Experience For People Not Like You

Senior Living Internet Shoppers Are a New Breed

How To Make AffordableAssisted Living Work For You

Importance Of Health Information Exchange To Senior Housing:

Barrier-Free Showers Made Simple

Changes To HIPAA:How Privacy And SecurityRules Affect Your Business

Managing with the Brain in Mind

Blowing the Dust Off the Lion and Crown

Talent Identification and Performance: Building a Championship Team

Highlighted Session

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Highlighted Session:

EXECUTIVES LOOK AHEAD, SHARE LESSONS LEARNEDSession panelists:BRENDA BACONPresident & CEO, Brandywine Senior Living

TIM BUCHANANPresident & CEO, Legend Senior Living

JON DELUCAPresident & CEO, Senior Lifestyle Corp.

TANA GALLPresident, Merrill Gardens

PAT MULLOYCEO, Elmcroft Senior Living

ANDY SMITHPresident & CEO, Brookdale

Panel moderator and ALFA Chairman Brenda Bacon got the standing-room only “Insights from the Executive

Suite: Future of Senior Living” session moving by asking Brookdale CEO Andy Smith to offer insight into the industry’s future as he works to merge his firm with Emeritus, creating the largest senior living business in the United States.

Smith said the merger “supercharges” Brookdale’s views on organic growth, investing in the platform such as physical assets and technology, its brand and innovation. He believes the industry will see more consolidation, technology will play a greater part in daily life and a changing health public policy landscape leading to lower costs with better outcomes and more seamless coordination within the post acute continuum.

THE POWER OF BRANDINGElmcroft Senior Living President and CEO Pat Mulloy touched on the value of a brand in response to a question from Bacon, who is also the CEO of Brandywine Senior Living. He said the training and systems processes available throughout the industry are better than 15-20 years ago, but “we’re still in the second inning of the ball game.” He agreed that a number of senior living businesses will “be out there” creating national and regional brands, but we’re not there yet,” said Mulloy, a member of ALFA’s board.

Jon DeLuca, president of Senior Lifestyle Corp. and ALFA board director, agreed, saying a regional brand has merit and strength. Technology today, including the Internet, enables smaller companies to create strong brand awareness

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among potential residents and their families even if they don’t have expansive physical assets like a Brookdale, for example, he said.

A NEW MODELSenior living communities are refining their services in response to resident and family demand. Legend Senior Living CEO Tim Buchanan said with new construction, Legend is now adding large theaters and installing café bistros in lieu of the more traditional ballroom style dining halls and more community hubs and places for people to connect. “I don’t want to be the nursing homes of the ‘90s…and watch some new concept take residents” from my assisted living business, said Buchanan, who is also ALFA board vice chairman. He added that adaptability is key when no one knows exactly what the future holds.

Merrill Gardens President Tana Gall says her firm’s focus has changed and it’s now expanding from independent living to accepting more assisted living residents. Many of Merrill Gardens’ new residents don’t necessarily need help with activities of daily living but they need socialization. “…The demographics are going to support all of our different types of services,” she said. “…We do not need to be afraid as an industry to go after the people who we can service better,” she added, noting that while the average age of a resident is 82, a 72- and 69-year-old couple recently moved in after spending the day at the community and “loving it.”

CHANGES AFOOTWhile construction is booming, especially in places such as Texas, and the industry is generally healthy, changes are afoot as it matures. Mulloy touched on “the beginnings of a whole new conversation about how our businesses are going to operate.” Those discussions among ALFA members and others include a new professionalization of standards and credentialing as increased scrutiny of the industry expands. Buchanan agreed, saying it’s important to customize within the industry but also to find commonality of standards and quality statements.

TOP FIVE TAKEAWAYS

1. There will be more regional and national senior living brands.

2. Senior living communities are refining their services in response to resident and family demands.

3. The industry will see more consolidation among increased scrutiny.

4. Technology will play a greater part in daily life.

5. It’s important to customize within the industry but to find commonality of standards and levels of quality.

Women in senior living executive positions shared their stories to

an attentive audience at ALFA’s 2014 Conference & Expo, regaling their starts in business, passions for older Americans and urging women starting their careers to pursue their dreams.

MEET THE LEADERSTIFFANY TOMASSO’s interest in senior living germinated when she was a 14-year-old volunteer at a nursing home. She was smitten then and continued on to take a job with Sunrise Senior Living in 1993 when it had 10 communities. She left in 2008 and formed Kensington Senior Living with some former Sunrise colleagues in April 2010. Tomasso noted that ALFA Chairman and fellow

CEOs SHARE THEIR CAREER

BRENDA BACONPresident & CEO, Brandywine Senior Living

LISA M. BRUSHPresident, CEO & Founder, Symphony Senior Living

VICKI CLARKDirector, Vintage Senior Living

SUE FARROWFounder, Integral Senior Living

TIFFANY TOMASSOFounding Partner, Kensington Senior Living

PATRICIA WILLPresident & CEO, Belmont Village Senior Living

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panelist Brenda Bacon gave Tomasso her first job as a senior living administrator when she was 25.

SUE FARROW was drawn to the industry at age 25 and is now founder and owner of Integral Senior Living. “I’m as passionate about what we do today as when we were naïve 25 year olds, not quite understanding what we were getting into,” she said during the “Insights from the Executive Suite: Women in Leadership” panel in Phoenix.

Brandywine Senior Living founder and CEO BRENDA BACON started her first nursing home in 1985. “Don’t think your age will hold you back from what you want to do,” she advised the audience of mostly women. “…Don’t wait until it’s your time to pursue where you want to go.” Brandywine soon will have 30 communities in five states.

LISA BRUSH started her career off on a different track – hairdressing. The Canada native said she loved the customer service aspect of it but at one point when she was flipping through a magazine in an unemployment office she realized she “wanted to do something that made a difference.” She started on the path to becoming a hospital administrator. She was also partly inspired by her mother who was a nurse in a psychiatric hospital in Montreal, full of stories from the geriatrics ward.

“When looking at your careers don’t pay attention to titles along the way. Look at the challenges you’re getting,” she said.

Her first job after obtaining a degree was to take retirement homes out of bankruptcy when she “fell in love with the business.” Her path, like many

others on the panel, also took her to work for Sunrise Senior Living and Sunrise REIT and then on to Ventas. Now, she is the founder and CEO of Symphony Senior Living in Toronto.

VICKI CLARK retired recently as president of Vintage Senior Living. She started in the business in 1982 in Atlanta and then moved to California. “Don’t look at yourself and be the person who stops you from growing,” she said. “If you don’t know how to read a set of architectural plans, find an architect. If you don’t understand financial statements, find a [chief financial officer] to tell you what it means.” Her supervisor prompted Clark’s move out West. “He took an unorganized 27 year old and mentored me to believe I could do anything,” she said, noting the importance of finding good mentors.

Bacon went and got a MBA at Wharton so that she could “learn enough so that no one can say you don’t understand it. …I will roll my sleeves up and go as deep as I need to go in order to make decisions.”

PATRICIA WILL said she had to learn quite a few things about management and business. “I was a real estate developer and I wasn’t running people,” she said. “I had to learn that. Ours is a high touch business.”

She initially got into the business at a time when she was working in medical real estate on hospital campuses and had a mother-in-law with early stage dementia. “The idea was that I could make not something better but something at all,” she said, noting that in the 1990s in east Texas where she lived there was no memory care communities

and very few assisted living campuses.She built 153 freestanding apartments and went home and had a good cry and meltdown “I was so frightened by what I had done,” said Will, the founder and CEO of Belmont Village Senior Living and a Harvard Business School graduate. Belmont now has 24 communities across the nation.

Tomasso called the panelists passionate, inspirational, innovators and teachers.

1. Find and learn from a trusted mentor.

2. If you don’t understand something, find an expert who will explain it to you.

3. Seek management and people training, especially in this “high touch” business.

4. Make sure you’re challenged in your career. Don’t focus only on job titles.

5. Don’t let your age hold you back from what you aspire to do.

TOP FIVE TAKEAWAYS

EXPERIENCED ASSISTED LIVING PROVIDERS SHARE

Signature Senior Living CEO Steven Vick moderated a conversation between several leading providers in the field of senior living on how technology can help efficiently and effectively deliver the quality care required in today’s modern communities with residents who have higher acuity needs.

Session panelists:SHAREE CUMMINGSVP, Signature Senior Living

SARA PADILLAVP, Quality Service Programs, Emeritus Senior Living

SCOTT RANSONCIO, Brookdale

STEVEN VICKCEO, Signature Senior Living8

THE CHANGING FACE OF ASSISTED LIVINGQuality Service Programs Vice President Sara Padilla with Emeritus Senior Living explained how assisted living has changed over the past decade: “Assisted living of today is the skilled nursing of 10 years ago. We’re dealing with more complex issues than we’ve seen in the past.”

With more complex medical issues and treatments and a registered nurse shortage looming, assisted living will be in competition with acute care hospitals for talent, so operators need to develop initiatives to recruit nurses. Acuity is rising. People want to age in place. Senior living operators need to try to allow residents to do that while complying with regulatory requirements.

Staffing has changed too. In the past, it was all about staff to resident ratio. Today, concerns, licensing visits and survey feedback, as well as continually administering resident assesments are used to dictate staff numbers and skill needs. Evaluation tools are vital to ensure services are delivered when needed - and to ascertain whom can best supply those services.

Vick questioned how providers monitor the cost of care and revenue to compensate for added care.

Emeritus’ Padilla agreed with Signature Living VP Sharee Cummings that it is about regular evaluations and staff feedback - all fed into a point-based acuity system. Brookdale CIO Scott Ranson pointed out that while points-based assessment systems work, nothing replaces talking to the nurses and residents.

When asked what the ideal solution was, he said: “We’d like to have what our customers would like to have.” He added that there are already wireless point-of-care devices in all the rooms to capture

data, so it would be good if these devices could help clinical staff with decision making. Padilla added that though the existing technology is costly, it is a worthwhile investment as the cost can be recovered through efficiencies.

MANAGING REVENUEThe best way to manage revenue is to look at real-time data and talk to staff to better predict revenue changes, Cummings said.

Each panelist had different approaches to manage uncollected payments. Cummings said it shouldn’t be a problem if you look at what’s causing the issues and address them, while Vick said daily billing could make a big difference. The panelists agreed that providers shouldn’t negotiate on care and that risk tracking systems can help. But the question is, when you have a customer that’s close to collection, how do you ensure that the assessment is accurate?

Cummings said this was done via registered nurses and clinicians using the points system, while Padilla pointed out that it’s important for nurses to ensure the assessment is accurate: “You better be able to say to an attorney that it’s an accurate representation of the care a resident needs.” That way, she added, the operators deal with money and the nurses deal with the care.

Vick said when he was appointed CEO of Assisted Living Concepts, he told the directors to bill for the services they had provided that day and this turned the business around. As for expenses, Ranson said there was an expense management tool managers could use to get a profits and loss (P&L) report to avoid surprises at the end of the month.

Vick asked about how to consider general services and supplies. Ranson explained that some vendors don’t have electronic invoices, so

the invoices are scanned to prevent them from getting lost in paperwork.

LEVERAGING TECHNOLOGYThe question of what’s next in technology for senior living operators was left to IT expert Ranson who said he had yet to find a best of breed software product that did it all, but said some vendors were getting close: “The industry needs it.

We know that the silver tsunami is coming. Automation, data, along with great care-giving is going to be what’s needed.”

Finally, on the topic of federal privacy law, panelists encouraged a systematic use of technology to protect the digital well-being of residents, as well as their physical well-being.

TOP FIVE TAKEAWAYS

1. The assisted living customer base has changed. Residents are older and have more complex medical needs.2. The best way to reconcile the cost of care and revenue is all about inputting resident and staff feedback into a points- based assessment system.3. It’s worth paying for the technology if it results in higher productivity and greater efficiencies.4. Look at the issues behind uncollected rent when alleviating the problem, but always ensure the assessment is accurate.5. Regulation means looking at the digital welfare of residents as well as their physical well-being.

UNDERSTAND YOUR AUDIENCEShe opened her talk by explaining that, no matter what you do, everyone has a customer, whether or not you sell goods and services. Your customer, your co-workers and even your suppliers can all be customers.

Kelly went on to explain the impossible triangle, a theory that dictates we can only ever achieve two of the three desired elements of quality, speed and low cost. However, Kelly pointed out that the paradigm is changing. Customers can have it all, citing the example of music downloads. In addition, customers want more; they want an experience that reflects their individual needs.

To do that we need to create a relationship and make the customer feel valued. And that means knowing who you’re talking to; understanding their priorities, values and the life experiences that define them. As Kelly puts it: “Perspective is never wrong. It’s uniquely yours.”

The challenge is to understand the customer’s perspective and make meaningful connections to it.

From a demographic point of view, matures, baby boomers, generation X and generation Y all have different values, drivers and perceptions of icons and events. Today, there is no average American consumer. She cited demographic expert Peter Francese: “The average American has been replaced by a complex, multi-dimensional society that defies simplistic labeling.”

CONNECTING TO YOUR AUDIENCEOnce you understand your customers, your next objective should be to use that understanding to connect with them. That means responding to their needs.

McDonald gave the example of a man who buys the same type of coffee at the same place every day while refusing to talk to the vendor because he’s always on the phone. But he always leaves a big tip because he gets what he wants - a quick transaction that doesn’t waste his time. But then there’s the elderly lady who leaves a big tip - when she buys her coffee, the waitress takes the time to talk to her during the transaction.

“It’s not the what, it’s the how.”

CRAFTING THE CUSTOMER EXPERIENCE FOR PEOPLE

Session panelist:KELLY MCDONALD

Marketing expert Kelly McDonald spoke about key topics from her book, Crafting the Customer Experience For People Not Like You.

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By understanding and filling your customer’s needs, you deepen the customer experience.

There can be very real differences between the sexes when it comes to transactions and the customer experience too. Women tend to focus on security and personal service; they want the truth, no pressure and plenty of choices. Men want convenience, simplicity and no more than three choices.

Even in the most generic service offering, you can beat the competition by understanding these differences and using them to modify your offering. Kelly gave the example of a hotel group offering free ironing services to businessmen. They understood that their target audience dislikes ironing. A car windowshield replacement service emailed women a photograph of the person who was coming to do the repairs, with the time they would be there because many women seek security built into the offering.

The trick is to use customer insights to develop loyalty in a meaningful way and tailor your offering to reflect that.

Doing this means finding out what people want, so it’s important to use avenues for feedback such as surveys. It’s also important to remember your customer-facing employees, who often have a unique perspective .

“Talk to your people on the frontline,” McDonald says. “Those people know everything.”

Be diverse when recruiting. This allows to you to maximize work styles, languages and culture, which can mean better results. Try to hire people who reflect your target market.

8 Ways To Deepen The Customer Experience

1. Ask stakeholders what they want. Surveys are good, but conversations are better;

2. Empower the leaders in your organization. Where there are three people or more, one will always lead. Find out who they are and cultivate them.

3. Use consumer insights when it comes to the sexes and cultural differences,

4. Walk the talk. Demonstrate that you do what you say. Don’t do false advertising - you’ll get found out!

5. Pay attention to trends and customize your products to meet that demand. Where possible, surprise and delight.

6. Be fearless. Be weird and unconventional if it keeps the customer happy.

7. Be the good guy. Develop a social conscious, whether that means being environmentally aware or contributing to the local community.

8. Helping beats selling by offering advice, not just information.

1. You can’t always give the customer low cost, quality and speed, but you can focus on giving them a customer experience making them feel valued.

2. Understand your customer – it’s our priorities, life experiences and values that define us. Strive to see these through your customer’s eyes.

3. Tailor your offering based on customer need. It’s not what you offer, but how you offer it that enriches the customer experience.

4. Find out what your customers are looking for by talking to them and your customer- facing employees.

5. Work at deepening the customer experience by adapting your offering and the way you sell it, based on trends and evolving customer needs.

TOP FIVE TAKEAWAYS

SENIOR LIVING INTERNET SHOPPERS

Session panelists:ANDY COHENFounder, Caring.com

JOSH EVANSSenior Vice President, Velocify

DJ GREENAGELDirector of Business Development, Directravel

The Internet consumer is very different than other types of consumers and how senior communities interact with them should be well orchestrated, according to online marketing experts. An Internet-savvy consumer is going to search on Google for a senior living community well before they give one a call, said Caring.com founder Andy Cohen at a discussion titled, Understanding the Internet Shopper.

He said even those companies that are savvy to the ways of search engine optimization or SEO, “are still probably not near the top of the [Google search] list” only because there are so many even savvier businesses out there.Reviews are what are really important, he said, adding that consumers click on, read

and consider reviews. Fellow presenter DJ Greenagel, Directravel’s director of business development, agreed. He said online consumers are educated consumers and reviews really matter to them.

“The average online shopper will know about your organization and do research online,” Greenagel said.

Today’s online senior living shopper is different from a few years ago, Caring.com also has found. For example, more than five years ago, the daughter of a prospective senior living resident generally would live in the market area of a community they contacted, would make decisions based on location and price and generally could visit a community during the week. Today’s Internet consumer lives out of town, starts a search on the Internet and researches those communities with

online reviews first and likely prefers email communications rather than via phone.Velocify Senior Vice President Josh Evans said his research has shown that most Fortune 100 sales representatives give up after one attempt, but six attempts over about 22 days has the highest success rate.

“In response time, a fast response has the greatest impact,” he said.

Caring.com’s research of online searches found that 15% of Internet shoppers looking for a senior living community search on a brand term, 29% search with the term “assisted living” and 20% conducted a general search and selected a familiar name.

Those factors highlight the need for an Internet presence and brand familiarity, Cohen said.

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TOP FIVE TAKEAWAYS

1. Internet consumers shop differently than other types of consumers.

2. Company and product reviews are really important.

3. Today’s online senior living shopper is different from just a few years ago.

4. When it comes to sales attempts, a fast response has the greatest impact.

5. Internet presence and brand familiarity is necessary.

Rod Burkett, President and CEO of BMA Management, Jerry Finis, Principal and CEO of Pathway Senior Living, and Wayne Smallwood, Executive Director of the Affordable Assisted Living Coalition, discussed how operators of senior housing communities can develop affordable assisted living strategies to capitalize on opportunities in a fast growing market. One of the best examples of this is Illinois’ highly successful Supportive Living Program.

MAKING AFFORDABLE ASSISTED LIVING WORK Almost every state has its own version of assisted living, according to Smallwood. Developing an affordable model means using a subsidy, such as Medicaid. Operators don’t need to solely exist through an entirely Medicaid customer base. A 60% Medicaid, 40% private split tends to be the most typical breakdown.

To develop an affordable model in a state, operators need to develop a strong relationship with state/federal agencies and the regulatory body. In the past, states relied on long term care through a nursing home model, but the assisted living model has evolved to care for a higher

Session panelists:ROD BURKETTPresident and CEO, BMA Management

JERRY FINISPrincipal and CEO, Pathway Senior Living

WAYNE SMALLWOODExecutive Director, Affordable Assisted

HOW TO MAKE AFFORDABLE

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acuity resident and strengthened in popularity. The number of people needing and wanted affordable assisted living is growing.

And, as Smallwood points out: “Assisted living saves money over nursing facility spending.”

MEETING THE NEEDS OF A GROWING SENIOR POPULATIONBefore discussing ways to fund new developments, Finis highlighted the importance of ensuring that the community accepted Medicaid: “It’s very, very important to have in the basic program a project-based system, not a voucher-based system. It allowed capital sources and capital markets to feel comfortable that the Medicaid subsidy would be there.”

Medicaid is changing the way operators deliver healthcare and cut costs. The government is driving that too, because the elderly are going to be the most costly population.

Affordable assisted living has to happen: • 7-14% of households are headed by an individual over 75• 40-50% of those have incomes less than $25,000• 38% needs help with three or more activities of daily living (ADLs)• Children of these seniors have less assets for financial support

DEVELOPING AFFORDABLE COMMUNITIES IN POPULAR NEIGHBORHOODSThe capital to fund developments can come from a variety of means, such as the Low Income

Housing Tax Credit (LIHTC) program, institutional investors buying tax credits, low interest loans and tax credits.

To be successful, operators must understand the financing options and build a strong development team that can work through the complexities. After that, you need to be committed to creating a high quality asset that will be competitive and last long term.

KEY OPERATIONAL ISSUESBurkett began by pointing out that his company offered the same quality services to all customers regardless of income or funding:

‘We don’t want to give the impression that affordable assisted living is really a different animal than regular assisted living. It just so happens that we take Medicaid payments as third party subsidy payments, so we can provide assisted living services to seniors of all income levels.’

His company, BMA Management, currently works in three states, but examined other states before

entering the market. The affordable assisted living model won’t work everywhere, so he suggested a few key areas operators should review:

STATE PROGRAM DESIGN – Every state is different. Examine the programs, regulations and agencies you’ll have to work with.

PAYMENT RATE – Some states don’t pay enough to make the affordable AL model viable.

PAYMENT CYCLE – Medicaid has a much longer payment cycle. Operators will need a reserve fund or credit line.

GATEKEEPERS – Every state has a different scoring system for pre-screening residents to ensure they need the level of care offered.

PROPERTY LICENSURE AND CERTIFICATION – Once licensed, even with residents in place, it can take two to three months before you get paid.

MEDICAID ELIGIBILITY – Authorities have to formulate budgets for Medicaid. When a Medicaid application is pending, the affordable assisted

1. The number of people needing affordable assisted living is growing fast. Providers should see this as an opportunity.

2. Providers need to understand all the variables when it comes to state programs, regulations and funding.

3. Adopt a split approach to Medicaid/ private funding. For example, 60%/40% seems to work best for most operators.

4. Fund new developments through the LIHTC program, institutional investors, low interest loans and tax credits.

5. Research the market thoroughly before incorporating affordable assisted living into your portfolio.

TOP FIVE TAKEAWAYS

THE IMPORTANCE OF HEALTH INFORMATION EXCHANGE

Session panelist:GINA D’ANGELOGeneral Manager, Eldermark Exchange

Eldermark Exchange General Manager Gina D’Angelo describes how joining a Health Information Exchange can help

community partners dramatically improve how they care for seniors, mitigate risks and reduce rehospitalizations.

WHAT IS A HEALTH INFORMATION EXCHANGE (HIE)D’Angelo believes HIEs will revolutionize healthcare by offering relevant, secure access to healthcare information: “We all know what happened with the Internet. It changed our lives. I feel really strongly that the exchange is going to change our lives in healthcare.”

Medication errors are a main reason for readmissions and the HIE will lower readmissions by improving diagnoses and decreasing duplicate testing.

Three main types of exchanges:• Direct Exchange – a secure way of sending and receiving info• Query Based Exchange – an easy, quick way to query data about a resident • Consumer Mediated Exchange – the patient takes control of information access and accuracy

Electronic Health Records (EHR) are becoming more important, driven by technology, patient engagement and legal regulation. Being part of an HIE means providers are able to understand who their residents are and how to manage their resources better in relation to the customer. Additionally, operators can demonstrate to the hospital that they have the information and resources to care for the resident, so the hospital may then allow them to stay at the provider’s building – meaning better care for residents.

PUTTING HIEs TO USEHealthcare is going paperless and this has to be able to happen without disparate systems. Penalties for readmissions are coming and performance will be based on how providers handle infections as well as company data.

In order to transmit data such as Continuity of Care Documents (CCD) regarding chronic disease, allergies, procedures and more, providers will need to be part of the Nationwide Health Information Network (NHIN). Operators also will be required to transmit data to a number of federal bodies and the HIE will facilitate this by allowing this information to flow through the various departments. It’s also important

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for providers to demonstrate they have the capabilities to make this happen:

“On the front end, you need to show that you meet the criteria and on the back end, your performance is going to be based on how you manage infection. And your performance is going to be based on how well you transmit data,” D’Angelo said. New federal privacy regulations in the Health Insurance Portability and Accountability Act, or HIPAA, are here. Especially with the new HIPAA rules regarding the business associate agreement, which says consent must come from residents. Different states will have different rules regarding opting-in and out. This will all be electronic, so being part of an exchange will be hugely useful.

Health tools are becoming more standardized with universal transfer forms and end-of-life directives, which are all becoming more frequntly used.

HIEs also will be important to bridge the gaps between software and applications. Right now, it’s working with electronic medication administration records (EMAR) and electronic health records (EHR), as well as older finance applications. The next step will be patient-centric, such as benchmarking applications. D’Angelo sees two typical HIE models emerging, the state exchange model and an ecosystem for senior living. With the state exchange model, once you’re registered in the state, you go to the suppliers, providers and business partners and ask if they want to be included. With the senior living model, you’re able to bring senior living agencies together, exchanging information and find the most appropriate partners.

10 THINGS AN EXCHANGE CAN DO:

1. Make life easier for staff with less paperwork

2. Simplify data management and make different types of data work together

3. Prepare for coming technology

4. Help keep protected health information secure

5. Demonstrate to hospital and state bodies that you can manage seamless transition of information regarding residents

6. Meet opt out/opt in requirements

7. Help select the best auxiliary providers

8. Meets the needs of a more resident- centric experience

9. Allow for immediate transfer of resident data from EMAR and EHR

10. Allow technology to be used to better understand chronic disease management

“It’s a great opportunity to say who do I want to partner with, in my town, in my state in my company,” she said.

The challenge is proving to the CFO that all this technology will diminish paperwork and antiquated technologies to improve efficiency and increase cost savings. D’Angelo finished with a ‘hands-on’ demonstration of a HIE.

TOP FIVE TAKEAWAYS

1. HIEs have the potential to revolutionize the face of healthcare.

2. HIEs can minimize hospital readmissions, improving care for residents.

3. Healthcare is moving toward a paperless environment.

4. Being part of a HIE will help providers cope with legal compliance, such as changes to federal healthcare privacy law and integrating new software applications in the future.

5. The key to convincing management to invest in HIEs is to demonstrate the cost savings achievable.

BARRIER-FREE SHOWERS

Quick Drain USA Vice President of Tech Support Josef Erlebach shared

his expertise regarding barrier-free showers designed to enable users to shower safely.

His company specializes in complying with the Americans with Disabilities Act and wheelchair-accessible shower installations where barrier-free and handicap showers are needed.

According to Erlebach, most barrier-free showers eliminate the traditional center shower drain and generally are easier to install. Barrier-free showers can be used in home and commercial projects such as health care settings, hotels, hospitals and condominiums. The need for easy-to-use and install showers is becoming more prevalent as about four in 10 assisted living residents receive assistance with three or more activities of daily living, according to a survey published by the National Center for Health Statistics.

These specially designed showers are usually flush with the floor, which allows users to safely walk or roll into the shower via a walker, wheelchair or other health aid without tripping

over a shower “curb.” They also need to be large enough to accommodate a user in a wheelchair and perhaps an assistant body. Erlebach said 60% of Quick Drain installations use curtains, 30% use glass and 10% are open.

1. ADA and wheelchair accessible shower installations are important features in senior living communities.

2. Quick Drain’s linear drains for showers are used to create accessible no threshold shower designs making it easier to roll a wheelchair straight to the shower.

3. The drain is ADA compliant and eliminates the traditional center shower drain.

4. Quick Drain is designed to remove all water and debris from the trough.

5. The majority of Quick Drain shower installations have a shower enclosure, but 10% have the open concept bathroom.

Session panelists:JOSEF ERLEBACHVice President Tech Support, Quick Drain USA

TOP FIVE TAKEAWAYS

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CHANGES TO HIPAA: HOW PRIVACY AND SECURITY RULES AFFECT YOUR BUSINESS

Session panelists:JOHN DIMAGGIOCEO, Blue Orange Compliance

CLIFF MULL

Blue Orange Compliance CEO John DiMaggio and Cliff Mull, a partner at Benesch of the Healthcare Practice

Group, educated the audience about the implications of updates to the federal health privacy law known as HIPAA, or the Health Insurance Portability Accountability Act.

WHY THE CHANGES ARE SO IMPORTANTPrivacy breaches are on the rise. “It’s not if; it’s when,” DiMaggio said. “There are a lot of breaches reported. You see them in the news. Once every couple of weeks, there’s a new breach.”

Dimaggio cautioned that technology is changing healthcare, and it’s imperative to protect the data you access digitally. There are more threats than ever, enforcement is stricter and the settlements are much larger. There’s the potential of damage to reputation, as well as the costs of fines, law suits, and legal fees. If an issue is found, you’ll be monitored for years. The key is prevention. If something does happen, any established precautions show you had safeguards in place.

Mull described the four different types of Covered Entities (CEs): • Single• Affiliated (ACE) - consisting of several CEs under common ownership• An Organized Healthcare Arrangement (OHCA) - clinically integrated, but separately owned organisations• Hybrid - with one or more components that are Covered Entities

Each has its own advantages and disadvantages. Operators should apply the most appropriate designation to their company before addressing HIPAA compliance issues.

THE CHANGES AND THE IMPLICATIONSThe classification of what is considered a Business Associate (BA) is more defined now. Before, certain health information companies and service providers said the rules didn’t apply because they didn’t have direct access to the data. Now, when a BA contracts out its services to another company, that company becomes a designated Business Associate too.

HIPAA is there to establish basic minimum standards that are often supplemented by individual state law and now has a much broader scope to protect all individually identifiable health information, relating to the patient or their condition.

BUSINESS ASSOCIATE RULE CHANGESThe rules for business associates (BAs) have changed significantly. For example, subcontractors cannot dictate agreements and are contractually liable for failing to comply with agreements or making reasonable efforts to prevent disclosures.

Other BA rule changes include:• Public Health Information (PHI) access can be restricted to the organization that pays for the healthcare. • Full disclosure must be given to any individual requesting their own PHI, or during a violation investigation.• PHI may be relayed to treatment providers, healthcare operations, public health/legal authorities and some specialized government bodies.

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• Authorization is required for psychotherapy notes, the sale of PHI, and marketing uses.

In all cases, both CEs and BAs must make reasonable efforts to limit PHI disclosures to the minimum necessary for the purpose of that disclosure. With regards to breach notifications, the CE or BA must make a notification within 60 days of discovery of the disclosure breach. If it doesn’t, it will have to demonstrate there was a low probability of a PHI compromise. “There is now a strong presumption and burden that any inappropriate disclosure is now a breach.”

PRACTICAL CONSIDERATIONSDiMaggio examined the practicalities of complying with the new rules. Security is about more than just confidentiality, he said. It’s about integrity, making sure the data is correct, and availability. It’s good business practice to protect all electronic

PHI, financial data, intellectual property, and customer information, he said. Although the biggest problem is human error, threats can come internally or externally. Environmental factors can be a problem too. For example, if a server goes down due to a fire or weather.

Review physical, administrative and technical safeguards. Restrict access to secure areas. Make sure computers and media are secure and password protected. Implement risk management assessments.

Address high priority issues first. Once these are resolved, reassess. The organization, the regulations and the environment are always changing. Continually review and document all work. Addressing a HIPAA breach can be very costly, not only in terms of fines or legal fees, but as a result of hiring specialized staff.

TOP FIVE TAKEAWAYS

1. Privacy breaches are on the rise.

2. The key to dealing with the new regulations is prevention.

3. Protect your organization, even if you think you’re affected by the changes.

4. Be aware that the rules have changed significantly for business associates.

5. The costs of dealing with a disclosure breach are higher than ever.

MANAGING WITH THE Session panelist:BETH BURBAGEVP of Organizational Development, Silverado

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Silverado’s vice president of organizational development, Beth Burbage, shared the

concept and importance of neuro leadership in guiding a successful organization.

The four domains of neuro leadership are DECISION MAKING, STAYING CALM UNDER PRESSURE, COLLABORATING WITH OTHERS, and FACILITATING CHANGE. The prefrontal cortex of the brain is where those activities reside.

Burbage said the goal of neuro leadership is to build confidence in employees to make independent and productive decisions benefiting the organization. An important part of this notion is to create an environment where thoughts and ideas can evolve.

She referenced a book by David Rock, Quiet Leadership. Rock wrote that the hectic and noisy workplace prevents us from generating the

best ideas and solutions. He emphasized that employees must have time removed from daily distractions and be encouraged to think freely without threat of ridicule.

Traditional brainstorming is not necessarily the best approach since it creates noise and stress. Burbage said “she often comes with the answer to something when she is not consciously thinking about it.” These are called “aha” moments and can occur when driving, walking, taking a shower or other unrelated activity.

The key premise is that these key moments can’t be controlled, but increased following four simple rules: being in a quiet state, looking inward, being slightly happy, and not forcing the process.

Burbage highlighted that management has a big responsibility in making the process work by creating opportunities for employees to access the deeper ranges of their minds. They should identify the problem or challenge then give associates the flexibility to solve it by tuning into deep thought.

TOP FIVE TAKEAWAYS

1. Neuro leadership can play an important role in improving employee productivity and morale.

2. The prefrontal cortex is the part of the brain where the decision- making involved in problem solving and idea generation resides. It has been the focus of neuro leadership research and exploration.

3. The best ideas and solutions normally are generated when the mind is relaxed.

4. The hectic and noisy workplace is a major contributor to preventing the best ideas and solutions from being formulated.

5. Managers need to avoid giving too much direction, not enough feedback and not being transparent about expectations.

BLOWING THE DUST OFF Session panelist:BRUCE HIMELSTEINChief Marketing Officer, Lowes

Bruce Himelstein, Chief Marketing Officer of Lowes Hotels and Resorts, shared

information about how to keep your brand relevant as consumer expectations change by describing the significant parallels between the senior living and hospitality industries.

After college, Himelstein started in the hotel business as a bellman in upstate New York. He eventually joined Marriott Hotels and rose to vice president of global marketing and sales before being asked to head marketing and sales for Marriott’s senior living communities.

Himelstein was reluctant to move from the hotel business to the senior living division since he knew little about it. Moving into a new arena with a “we don’t do it that way here” culture, he simply listened for the first 90 days.

A quote that has served him well professionally is:

As humans we are tempted to embrace a likely scenario and stick to it, but in these vulnerable times the smart idea is to pursue multiple paths and not be afraid to change direction.

Using that quote as his guide, Himelstein proceeded to shift the business from being 100% health care driven to a sales and marketing driven organization with the primary focus on health care.

Believing that occupancy coupled with a rewarding experience is the key to profitability in both the senior living industry and the hotel industry, he introduced new training programs, new guidelines for hiring people and performance incentives without sacrificing the major goal of maintaining quality service.

Next, he embraced the challenge of changing the brand dynamics at Ritz Carlton hotels after its acquisition by Marriott. It was a luxury brand that was stuck in time.

The financial crisis of 2008 had created havoc at Ritz Carlton. Companies told their executives not to submit expense accounts that included stays at Ritz Carlton and other luxury properties because of lay offs and cost cutting initiatives.

Himelstein and his team created the “Blowing the Dust off the Lion and Crown” strategy, which positioned Ritz Carlton as a place for a younger demographic including families that

were more experience motivated and willing to pay appropriately for it. The new message was value driven to meet the discerning affluence profile rather than the status seeking profile of the past. The strategy worked by using “mini films” of people sharing their Ritz Carlton memories along with social media marketing.

He encouraged senior living marketers to always look at the situation from the lens of those who do business with you and to stay ahead of the changing environment with innovative approaches to senior living care.

Himelstein stressed that people are willing to pay a premium for excellent service and said senior living communities have that opportunity. He cited comedian Steve Martin that you be “so good, they can’t ignore you.”

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TOP FIVE TAKEAWAYS

1. Organizations must be willing to change with the times to succeed.

2. Listening is one of the most effective tools when initiating a cultural shift in an organization.

3. Always look through the lens of those who do business with you.

4. Stay ahead of the curve and be aware of changing consumer behavior however slight it may be.

5. People are willing to pay a premium for excellent service and a rewarding experience if you are “so good, they can’t ignore you!”

TALENT IDENTIFICATION AND PERFORMANCE: BUILDING A

Session panelists:JENNIFER SHIRKANIPresident & CEO,

Penumbra Group President and CEO Jennifer Shirkani offered tips for “Building a Championship Team.”

Shirkani’s talent management consulting practice provides leadership development, hiring and selection consulting as well as training and performance coaching with a focus on emotional intelligence.

She emphasized that in the fast-paced business world, low performers often drag on an organization in unexpected ways. High performers get so frustrated by the low performers that the highest performers leave the organization for other opportunities while the lower performers stay in place.

“A 2013 Gallup study revealed that only 30% of employees work with passion and feel a profound connection with the company they work for,” Shirkani said, adding that those who essentially have “checked out” represent

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52% of the employee universe. Those actively disengaged and who are unhappy employees make up 18%. They regularly undermine the organization and co-workers, and they can undermine what motivates top employees.

For employees to stay engaged requires management to stay in tune with what is most important to the individual employee.“Low performers are high maintenance,” she said. They get a disproportionate amount of attention from managers.

High performers are low maintenance but often feel ignored by their superiors and need affirmation that they are performing well.

She stressed that “to build a championship team, everyone in the organization must be engaged.” To accomplish this requires management to have strong Emotional Intelligence (EQ) skills, which help in monitoring their own and staff emotions. It’s similar to Intellectual Intelligence measured by IQ. They must be self-aware, flexible, empathetic, practice self-control and exude optimism.

A manager can improve or develop EQ skills through formal training programs, individualized coaching, reading and learning more about EQ. They also should interact regularly and practice their EQ skills with those in the organization who rely on the manager for leadership.

1. Exceptional performance is the perfect alignment of skills, rewards, feedback, management style, measurement and culture.

2. To have engaged employees, management must understand and respond to what motivates and inspires each employee to do a job well done.

3. Engagement refers to an employee’s willingness and ability to contribute to the

success of the organization they work for.

4. To build a championship team, management must hone their Emotional Intelligence (EQ) skills to be effective in leading their organization.

5. The key attributes of an engaged manager are to be self-aware, be flexible and empathetic, practice self-control and exude optimism.

TOP FIVE TAKEAWAYS

REGISTRATION IS OPENALFA 2015 Conference & ExpoTampa, FloridaMay 4-7, 2015

www.alfa.org/conference