Some initial conclusions as we head home........to be further refined

·      There is no magic bullet. Social housing/housing for poorer, older people needs to be subsidised one way or another by government

·      The “Golden Age” of support for social housing in the UK and Europe is coming to an end

·      Well-planned communities and well-planned housing units maintain options for older people so they can continue to exercise choice

·      Our organisations need to promote mindset change – younger, older people need to plan and act earlier rather than later about their housing choices to maintain their options

·      We can provide much more comprehensive advisory services and practical support to family homes and retirement village units to help people maintain their options for longer

·      We need to press for changes to building and constructions regulations to facilitate cheaper building approaches

·      Assisted living and sheltered housing are better options than low care – providing housing as the primary service and care/support as the back-up service

·      An argument can be made for large scale, “full service” retirement communities – in relation to this we need to make sure we are respecting what customers want and not what we want

·      Where providers co-exist (eg Menora), much greater effort needs to be devoted to offering collectively the fullest range of services possible

·      Stepping outside the system and doing it your way may be the only way to provide people with what they want in the over-regulated Australian setting

·      If we want change/truly believe in what we’re doing, we need to be prepared to disobey and just do it

In Washington DC

This is an impressively planned city, much like Canberra(!). The Capitol Hill district runs between Capitol Hill and the Washington Monument. The green National Mall joins the two book-end monuments and it is flanked on each side by very impressive Government and Museum buildings. It is a very impressive site – the equal of the great European cities. It looks fantastic at night with the buildings lit up.

As grand as the architecture is, the service at times is terrible. I’m still having trouble with cab drivers and waiters etc. It offends me to find people who are so poorly attuned to the needs of visitors to the country, particularly as there are thousands of us. If you know what you’re doing and know exactly how something works, you’re fine. But if you want some explanation or something out of the ordinary, too many people switch off their customer service ”façade” at this point. Or maybe I just expect too much…..

We visited the Capitol Hill Village (CHV). They are a membership-based community association, dedicated to enabling the older people of the Capitol Hill area to remain in their own homes for as long as they can. This organisation is like a NORC (Naturally Occurring Retirement Community) except for the fact that Capitol Hill Village membership is open to all age groups while a NORC is more like a self-help organisation for older people.

CHV raises funds from membership and fundraising and then provides volunteer support to people to take them to appointments, get repairs done to their homes, provide companionship etc. This sort of community association is of interest to me because I was responsible for trying to establish them in the UK before I escaped to Australia. CHV links into other service providers, health facilities etc to try to package together supports for people.

At one level, there is nothing too remarkable about this for us. Our own organisations are providing similar community supports to help people stay at home and we have locally-based community organisations in WA who do something very similar to CHV.

Having said this, there are points of interest here. First, Kathie from CHV pointed out to us that they are essentially supporting people “stuck in the middle”. These are older people who don’t have so much money that they can pay for all the support services they need privately but, unfortunately for them, neither do they have assets that are so low that they qualify for Medicare and Medicaid. So, they are the “asset rich, income poor” group we are familiar with and they have trouble being able to stay put through older age.

Now this segues nicely into the second point of interest. Kathie explained that these older people don’t just want to stay living in their own homes, they want to stay living in their own community. At one level, they could relieve their predicament by divesting themselves of their current assets  so as to qualify for benefits, but that would require them to sell up and move from their own community. Of course, this is a special, if not a unique community, right next to Capitol Hill in Washington.

It was good to visit CHV because it provided a diametrically opposed proposition to that of Erickson Communities. The members of CHV are passionate about staying living near Capitol Hill for as long as they can. Poorly serviced and isolated, as they may be. On the other hand, the people who had moved to the Erickson Communities seemed very happy with their choice, which was delivering so much to do and so many people to mix with.

You can go round the world, but fundamentals remain the same. Choice is the thing or the thang as we say round here.

By the way, that was our last visit and not to put too fine a point on it – Vaughan and I are knackered.

To Washington or DC as we call it (now)

We were transported here from Baltimore by the most delightful man, Eddie, who is a driver for Erickson. He is an older African American, native to Baltimore, and we enjoyed hearing about life in the “real Baltimore”.

We met with David Schless, CEO of the Australian Seniors’ Housing Association ASHA) – the equivalent of ACCA in Australia.

He explained that the construction of seniors’ housing had all but stagnated in the wake of the GFC. He said that the capital markets had become incredibly tight and that people were putting off investment decisions, indeed all decisions while there was so much uncertainty about the US economy. As a consequence, rental housing models were faring better than lease-for-life product as the decision to rent was a more conservative one than shelling out a huge lump sum amount.

He said that the US had little social housing product or retirement communities for poorer, older people. There was some aged-friendly housing, but for the most part poorer people had to make do as best they could in the private rental market. David’s view was that the USA’s economic circumstances would prevent any expansion of social housing provision in the foreseeable future.

From the various discussions we’ve had here, it is clear that, while housing is considered to be a personal responsibility of people even if they are old, health care and community care are not. At the age of 65, “pensioners” in our terms qualify for Medicare and Medicaid benefits. We have been quite surprised at the level of support that is provided to older “pensioners” in the US. It’s obviously a significant cost burden on government and many people have questioned whether the current level of benefits is sustainable. I’ll return to this subject a bit later when describing Capitol Hill Village.

We took the opportunity to talk to David about how effective his industry group/ association was at influencing government on key issues, noting of course that his association in based in Washington, the seat of government. He said that this organisation was influential and he cited the reasons for this as being the retention of specialist lobbyists and the creation of the Political Action Committee (PAC).

The PAC is interesting. It is used to support the campaigns of sympathetic politicians. It is illegal in the US for organisations to donate to such committees and so it is supported by personal cheques from supporters/influential members. This fund raises up to $500K per annum – now that should purchase some influence!

David stressed that the association’s influence on Capitol Hill is achieved by developing sustained, long-term relationships with politicians. My interpretation of this would be that you can establish such relationships if you are out and about as an association in the seat of government.

Compare and contrast Baltimore

Today was another big day on tour.

We saw another of Erickson's sites, a not-for-profit competitor's site of a much smaller scale (400 people) and a site providing a rental model in the assisted living/residential care space.

The Erickson model and the smaller competitor's approach allowed us to compare and contrast delivery systems. Erickson has road-tested its approach and adapted it continuously to service opportunities and market trends. They have continuously adapted the services offered, the style and size of apartments and do a complete make-over of each site every five years. Because of their massive scale they can also deliver services, undertake construction etc at a much better rate than smaller operations.

The smaller, NFP alternative has found itself in a place not unfamiliar to our NFP providers. It has been running profitably and has built up reserves. Existing residents have been happy and the model has remained in place for decades. However, seemingly, all of a sudden to them, they are experiencing vacancies and their amenity and accommodation units are no longer hitting the mark. They have now entered into a huge and rapid refurbishment program of their common facilities, restaurants etc but from our point of view had not undertaken a full strategic analysis to determine the full picture of what their market wants from them in the future. I asked the question - what's more important to your customers, upgrading the communal facilities or updating the accommodation units? Their response was that they just don't know, but they hope they are doing the right priority first. This is a classic reminder to plan, aim, fire rather than in any other order.

The site offering the rental model in the assisted living/ residential care/ dementia care space is part of the Sunrise group. They are a very large and apparently very successful company that operates facilities of a much smaller scale (100 units) but does not own the sites. They pitch their services to the middle to upper end of the market. On top of the basic rental for the room, they then charge people on a fee-for-service basis for their additional services.

We were generally impressed with the design of the accommodation, the more intimate feel of the operations and the caring approach to their dementia-related customers (in the "Reminiscence" wing)! It seems that the USA is one of the few countries where the rental model has taken off in a big way. Erickson does not see itself in competition with Sunrise in that Erickson is in competition with people who want to stay living in the family home. Erickson's "lease for life" model would appear to provide a better "peace of mind" deal to people than a rental approach where some people live a lot longer than they expect to and actually run out of money to pay the rent.

The Erickson community we visited today was their original one (Charlestown). It is on the site of a disused seminary of historical significance. As part of the approvals process, the chapel in the seminary has been completely restored and it is an unbelievable marble-lined structure of amazing proportions. The chaplains in our organisations would kill for this, figuratively speaking of course.

We also spent a lot of time with John's son, Mark, today and had the chance to discuss philosophical, management and leadership issues with him over dinner. This was interesting. Mark's views are more liberal than many of the older "market is king" people we have met here. He sees a meaningful role for the State in providing safety nets for people and his line on such things as Obama's health reforms is pretty similar to how most Australians see these things.

We found ourselves on a good wavelength with Mark on most issues. However, after a beer and a wine or two, we had a great discussion about "what is the best way for older people to live?" Here, we found we were coming from quite different standpoints. Our view is that people should stay living in their own home and in their own community for as long as possible. Having been asking the questions and doing all the grilling of people for the last 3 weeks, we found the boot on the other foot.  Mark questioned why this is best when so often it is a recipe for isolation and for people to stagnate and become inactive? After all, isn't it true that if you don't use it, you lose it? In this respect, Mark is firmly in the same camp with his Dad - living on a well-resourced community campus gives people 75 plus another lease on life.

The Erickson group has a research facility into ageing, a training group and various philanthropic foundations. Mark teaches at the training facility and has learned a lot about management over his short career, partly through adversity. In all fairness, we should point out that the Erickson group got into financial trouble during the GFC by diversifying into untried markets at the wrong time and it was eventually bought out. John retains a role as the R&D man and as founding guru.

It's been a great visit with the Ericksons. It has been provocative for us - see Sarah Mitchell's comments on this blog. At the end of the day, Vaughan and I agree that you can't take a view like John does that there is one best way for older people to live. We stick to our guns that it is all about maximising the range of choices for people. We think that this time spent with the Ericksons has essentially broadened our view of the spectrum of choice that can be offered to older people. Erickson Communities are what you might call "full service communities" that offer a lot more than traditional retirement villages in WA due to their massive scale and core philosophies. Could they be made to work in WA or more likely the Eastern States? We'll need to ponder that one.

Ray

Erickson

Made our way to Baltimore today on AMTRAK. I had some trouble communicating with the locals about the fact that we didn’t understand how the system worked. It was later explained to me that New Yorkers are too busy with their own busy lives to explain to the ignorant how things work. I felt better once I understood that.

We had a fantastic day today hosted by John Erickson, the founder of Erickson Retirement Communities. Where to start? Well, John is a self-made man. He was one of fourteen kids in a poor family and they were in the Guinness Book of Records for the most graduates out of one family. 14 out of 14! I won’t even begin to try to explain the trials and tribulations he went through to get his first project started. He now has 30 of them providing accommodation and care to tens of thousands of older people.

As we’ve stated on the blog before, it’s essential to try to understand the culture of the country and its communities before you can start to talk about and evaluate their various projects. I think the interesting thing here is that John has a very clear and firm view about what is good living for people 75 plus and that is to live in a supportive community with excellent health care, social and developmental opportunities and support. In this context, views about the design of his communities and their degree of institutionalisation become almost irrelevant. Erickson communities are unashamedly institutionalised in our terms, but they believe it is the right way.

Today we visited Riderwood just outside Baltimore. It is a community on a huge site of – wait for it – three thousand people. It is designed as a retirement community for middle America and consists of retirement living, our equivalent of hostels and dementia-specific units, 7 community centres, 7 restaurants, shops, major rehab and restoration centre, pharmacies etc and….a TV station providing internal programming staffed by a co-ordinator and volunteers who have had some background in the media and... the best thing of all…a primary health care facility.

The choice of independent living apartments is impressive. Nothing out of the usual for us but brought to market at half the price. The lease for life arrangements are broadly comparable. The care facilities are also broadly comparable with what we provide.

But there are some amazing things in this community:

·      The sheer scale of it that allows so much to be provided on site

·      The employment opportunities provided to African Americans, some of whom have risen to the very top echelons of the staff group

·      The scholarship scheme offered to young people (almost exclusively African Americans) that provides incentives to young people to continue to work at Erickson Communities in the form of cash support to complete their education. This program , originally supported by the company, has been augmented by support from the residents who also wanted to help these young people.

·      The health care program that provides access to onsite GPs supported by a same day policy for appointments to see a Doctor. This community has 7 GPs employed by the company! We met the Head of this service and he was incredibly passionate about his work there. He was previously very disillusioned about working in the general health system and is quoted as describing that experience as being “I used to be a Doctor”. Once he spent 11 minutes with patients, now he spends up to 25 minutes. John Erickson believes that excellent primary health care is the key to good ageing. They provide very compelling statistics to justify their base proposition that ready access to primary health care substantially improves the health status of the older old,

The very notion of a three thousand strong community of people 75 plus is unacceptable to us in so many ways. I asked John what he thought about creating such a huge ghetto for older people when it would be possible to weave younger people into a mixed community. He argued that we all had a good time when we went to College and that was all people of the same age group! the sites are called "campuses" and that is to designed to convey the feel of the experience. I think the refreshing thing about John is that he doesn’t apologise for what he is doing. He is 100% convinced that what Erickson Communities provide for people is what they want and is the best thing for them.

In a funny sort of way, we reflected on the fact that John Erickson and Hans Becker from Humanitas in Rotterdam could not be more different people but they have very similar leadership qualities in common. They both have an absolute conviction about what is good living for older people and are prepared to buck the system to deliver on their beliefs.

Culturally, we remain sceptical, but I’ll tell you this. Walking round this community with John, you’d think he’d set it all up. So many residents and staff came up to John and thanked him sincerely for what he was doing. He is held in great reverence by people. He is incredibly wealthy and successful now but maintains a common touch. You can’t learn this or fake it. You either have it or you don’t.

This was a great experience today. Despite yourself, you can't help but admire what John  is doing.

Ray

New York, New York

What a town!

Somewhat jetlagged for our day off in the Big Apple following the flight form Europe. Nonetheless walked half of Manhattan today trying to visit all the streets in the Village and Soho and Tribeca I can remember from Woody Allen films.

The scale and density and diversity of this city is incredible. It has everything you want and the best and worst of it all, with everything in between. You walk past the beautiful people (including Vaughan) and the next step you're walking past a down and out who's just been sleeping in the doorway.

I'm not having any trouble getting a coffee here and my eggs are coming easy over (whatever that means).

Our hotel is pretty lively and funky. The hotel calls its front desk service "Wherever, Whatever" because that's the service they give you. I've only asked for one thing so far. I asked at 7.30 this morning and it still hasn't been done. I passed on my Chairman's wise advice that he sometimes gives to me - under-promise and over-deliver.

Off early tomorrow to Baltimore to start our US visits.

Ray

Humanitas Akropolis

Well, what can you say about this? This is aged care going out on a weird date with Johnny Depp.

This place really works. It's driven by outrageous, narcissistic leadership; a culture that says yes and accepts anything people want to do; brilliant design that looks dog-eared like your favourite book; interior design that is so over the top it continuously assaults your senses AND maintains your interest; in our terms, a huge scale that permits experimentation and risk-taking and the opportunity to make expensive mistakes.

It really does work. We arrived early and plonked ourselves in the space to see what really happens and to avoid any spin. The main area is an internal atrium, a "sheltered village square" as they call it. The affordable housing flats open onto it. It works on the same principle as our new office - you have to walk through the village square to go anywhere so you have to meet people whether you want to or not. Anyway, the village square had a thriving restaurant, a craft and jewellery market, a bar, a pool hall, a convenience store, an internet kiosk space and it was very lively. Most of the people were old, many with walkers and buggies, but there were younger people too.

Not surprisingly, the staff wandering around seemed engaged and happy. They seemed to enjoy working there and no doubt this rubbed off on the residents.

We visited one of the affordable apartments. It was quite large for Europe and had universal design and smart wiring. Incidentally, the building is relatively new (built in 1992?) but it looks bloody awful like the Perth Hyatt. We've seen some stunning, modern design on our travels in Holland. But while most of those seemed sterile and cold, this place looked comfortable - the sort of place you can knock your drink over and it won't matter.

When we left the village square and visited the therapy rooms and the medical suites, it was like putting on your 3D glasses to view the weird and wonderful. It was a sort of menagerie of artefacts and peculiar murals so your mind would be on the stimulation and not on your ailments or your treatments while you sat around to wait or received your therapy.

Finally, we went down to the basement, which is like the size of a city block. This is where the drugs were really kicking in. This is like the greatest social history museum you have ever seen. You walk from room to room where a different aspect of life in Holland over the last 100 years in depicted in minute detail. There are thousands if not tens of thousands of everyday objects laid out there. It is mind-blowing.

Being a small group of very nosey people, we seem to be able to dig under the surface and find out what life is really like. Obviously, having a charismatic, outrageous, reckless leader like Hans Becker would be hard going for the other staff. People like that need the support of very stable and reliable people to focus on the detail and get the job done. They also need ambassadors and interpreters who smooth over relationships with those who are struggling to keep up in the wake of innovation and change.

Let's not kid ourselves - there's no way in the world that any of our organisations could replicate what is going on here. And in the Australian setting, we probably wouldn't want to. But what we can do is - stand up to the boring regulators, dare to be diferent, commit absolutely to a yes culture and the biggest impact of the whole thing for me - create environments for people that are really stimulating and interesting.

Humanitas is very good at marketing itself. They tell everyone how good they are - and they are!

Ray