Loren Shook is no stranger to the LTC community. The president and CEO of Silverado Senior Living has built over the past 15 years a successful company specializing in a full continuum of memory care with its home care, assisted living and hospice service lines. Its business model—featuring expert clinical care (medical directors and RNs in addition to LPNs on site 24/7), advanced staff development and the presence of pets and children in its homes—has been studied and copied by developers across the country. In this interview with Editor-in-Chief Patricia Sheehan, Shook speaks to the opportunities and challenges for memory care providers.
WHAT SHOULD INTERESTED DEVELOPERS KNOW ABOUT MEMORY CARE?
Developers really need to understand the program they wish to provide operationally. Everything revolves around that and if you want to provide a full-scale program as Silverado does—from taking earlier-stage cases through the end of life to accommodating the most complex cases behaviorally and medically—you have to design staffing and your operational plan and budget accordingly. And that will make a difference in the physical plant you build.
In terms of changing our design model, we’ve increased the amount of common space in our new buildings with more space for people at the end of life to have more of a unique sensory location for them—[to enable] more touch, feel and smell sensations. We have a great deal of natural lighting in the communities and we’re adding larger entry/living rooms, bistro kitchens and more amenities with nicer finishes.
DISCUSS CHALLENGES FOR THOSE NEW TO MEMORY CARE
If you’re new to the business it will be challenging to get financing because lenders want operators with proven success. Financial groups have been burnt in the past betting on new operators thinking the most challenging part was the entitlement and project construction whereas they’ve learned the most challenging part is operating it. So you need a plan: know whether you want to take earlier or middle-stage cases [of dementia]. It’s a different economic/operational model.
Then you need to know when to transfer [residents] to another setting—that’s a challenge to know and convey that to your staff. The earlier and middle-stage care is filling assisted living today—especially the earlier stage but as [residents] progress to the middle stage the natural tendency is for [providers] to not want to lose the people they become attached to so there’s a built-in denial process that can happen to the best of operators. To guard against it you should have a trusted outside source who will tell you the truth relative to the cognitive functioning of the people you’re serving—an expert in the diagnostic realm like an outside physician or nurse practitioner.
HOW IS THE INDUSTRY PROGRESSING IN MEMORY CARE?
There’s an increasing knowledge out there and skill set and that’s a good thing but I don’t see anyone doing what we do at the level we do it. But I see people developing programs that are much better than what was available before. The level of programming in the markets we operate in has increased overall—the addition of nursing services, groups adding pets, a greater knowledge and understanding of what can be accomplished—although there’s a huge dearth of understanding that people with dementia can perform at the level they do in the new markets we go into.
[Consumers] think they’ve found the best in town but our level of service is so different—things like getting those to walk that couldn’t and those that couldn’t feed themselves to do so and cutting down the use of prescription meds—and they look at us like we’re lying to them. Family members get upset. They get upset because they’ve studied hard to find the best place and they thought they did and I’m telling them this isn’t the best place—that there’s a better level of service. The fact that it wasn’t available to them in their market is lost on them because the emotions and the guilt come to the surface and the irrationality of feelings is present in the anger. They don’t understand that they did the best [they could] for their [loved one].
CAN YOU ADDRESS THE REGULATORY CLIMATE CONCERNING MEMORY CARE IN AL SETTINGS?
We work diligently with our state ALFA (Assisted Living Federation of America) chapters and that’s essential. I’m the vice chair of ALFA’s board. It’s a moving picture; the recent increased focus from the government on assisted living, that HHS (Health and Human Services) included AL in its draft—they didn’t have it before in its draft and ALFA jumped in and said AL is a big player here in the Alzheimer’s world.
The focus on Capitol Hill is on Medicare/Medicaid programs and some would like to nationalize the assisted living regulatory process and make it the same as we have with CMS programs. [Regulators] don’t understand assisted living but understand skilled nursing. The beauty of assisted living is you can design a program to meet a population you’re targeting, with multiple price points accordingly. It’s a terrific benefit of this model of care. It is really important that all of us are operators are involved with our national organizations to protect our freedom to be able to innovate.