A Texas continuing care retirement community (CCRC) is in the midst of a widespread repositioning project to transform into a hospitality environment focusing more on independent and assisted living rather than institutional-style skilled nursing with an eye toward long-term sustainability.
The C.C. Young campus, in Dallas, Texas, contains many buildings built in the 1960s and ’70s. Care levels include independent living, assisted living, memory care, skilled nursing, rehabilitation, home health, and hospice.
Ten years ago, the CCRC had about 240 nursing beds. Today, it’s licensed for 134 beds and operates around 90. In August 2011, a 108-unit, $54 million independent living building opened, and the CCRC has also gained 66 assisted living units with plans to add more, along with additional independent living units.
The transition stems from futuristic thinking.
“That’s the way we’ll be able to stay in business,” says Russell Crews, C.C. Young’s executive vice president and chief financial officer. ”People learned a long time ago you can get most of the services you get in a nursing home in assisted living, and it’s a home-y, inviting, warmer environment.”
The other thing C.C. Young is promoting through the campus is personal care services, so people can age in independent living longer and stay longer in assisted living, says Crews. THe CCRC has its own hospice and home care services that it promotes for residents, who also have the option of contracting those services with a third-party.
“The time you spend in the nursing home is going to get less, probably each year going forward,” he says. The goal is to get to a six-to-one ratio of independent living units to skilled nursing beds, along with adopting a small house/greenhouse model for higher levels of care.
For the past several months, the community has been undergoing a substantial repositioning of unit mixes. D2 Architecture, a Dallas, Texas-based firm specializing in senior living design, was brought in to aid C.C. Young’s efforts.
“Things are not broken at C.C. Young, though—they’re going in and fixing something that’s good, and making it great,” says David Dillard, president at D2. ”A really good trend we’re seeing is converting unused common areas to units, although I don’t see it [happening] that much.”
At C.C. Young, some rarely-used communal spaces on the upper floors of the assisted living building are being converted into nine additional assisted living units—at an “obvious” financial advantage to the community, Dillard says.
The bottom floor will also get a makeover, with plans for a new dining area, new art studios, and new meeting areas. D2 recommends putting everything from coffee shops, mail rooms, and TV lounges in central locations where people are forced to interact, instead of being shut away behind closed doors in their rooms.
The next wave of the project is for the community’s rehabilitation buildings.
One of D2′s architects, Keith Wilson, recently conducted a “sleepover” at C.C. Young—a movement pioneered by the design firm where an architect goes to a facility and spends a night as one of the residents. The twist: Each architect is assigned a disability a senior may have, which helps him or her figure out exactly what a potential resident might go through and how to make life easier for that person.
For Wilson’s sleepover, he was given the symptoms of being a right-side stroke victim and couldn’t use the right half of his body. Takeaways from his experience include plans to create rehab units that are similar to what a recovering resident’s home is like.
“You need [a setting] like your house, so caretakers can teach you how to go home, and cook, and use the bathroom, and go down the hall, etc.,” Dillard recounts of Wilson’s findings.
In many communities, that’s not the norm. Generic rehab rooms have often been designed as a space where someone’s going to live the rest of their life, for perhaps their final six months or a year, according to Dillard, rather than functioning as a stepping stone back to an assisted living or even independent living unit.
“We’re going to employ Keith’s takeaways to make common spaces with fake kitchens and bathrooms that are great training for someone who just wants to go home,” says Crews.
Many parts of the project are being financed with community cash-flow rather than a bank loan.
“We’re seeing a lot of focusing on repositioning, laser shocks on various parts of the campus to make it better,” says Dillard, who says he’s getting calls to do projects at other communities ranging in cost from about $1-1.5 million. “There are pieces of work on C.C. Young’s campus that are [costing] half a million, where you zoom in, spend the money out of cash-flow, and get a great reward for it from a marketing standpoint.”
Already, the 108-unit independent living community that opened two summers ago has achieved positive cash-flow. “It took about 24 months, and our Pro Forma study had said about 28 months,” Crews says. “We’re trying to move into a quicker return [on investment] than we’ve seen historically. “
It’s too early to speculate on costs of the project, he says, especially as the number of new units is still unknown for another independent living community that is planned to take the place of an existing, institutional-style skilled nursing building.
“My guess is, at some point, standalone skilled nursing facilities are going to be few and far in between,” Crews predicts. “You need a campus that drives through the continuum of care as people go through different aging processes, and we want to be positioned to take advantage of that. I believe the CCRC is the most sustainable way of the future.”
Taking a proactive approach is the best approach, Dillard says.
“Rather than looking at a community and thinking, ‘This is in trouble, what do we do now?’ it’s, ‘This is working now—what’s the landscape going to look like 15 years from now?’” he says. “That’s fresh thinking.”
Written by Alyssa Gerace