Catching up with Dr. Bill Thomas at SABRA Operators Conference

Jun 28th 2019

For as long as I can remember, we wanted to completely revolutionize nursing homes because when I started as a high school volunteer in the mid-eighties, I could see there had to be a better way. This time period was painful for nursing homes that were being steadily expanded, coupled with growing sentiment that the care was often poor, triggering what we know as OBRA legislation (1987) to improve oversight by the government. It was massive regulations that have never really slowed down.

My team and I at Signature HealthCARE have always dreamed of a day we could transform an industry covered in negative perceptions related to what we all want it to be and what limited resources combined with excessive regulations that often hold us back. We can hold a long-term care history class later, but Dr. Thomas is why we have 57 Eden Communities today at Signature.

When we tried to find a framework to use to innovate around us, we learned about Dr. Bill Thomas’ body of work around culture change, wise leadership, and new designs to reduce institutionalization of elders. We all read his books and in particular used Second Wind to see a brighter future for both stakeholders and customers. In this process, SHC started to study Eden Alternative, use part of the Green House Project concepts in our older centers, and worked with the Pioneer Network to become one of the largest Eden Alternative milestone organizations in the U.S. Most of my inspiration came from Dr. Thomas; to be bold about change, embrace innovation like never before, and become a passionate life-long learner of what is possible to reduce my dependence on my own prior experiences.

I had a great opportunity to hear Dr. Bill Thomas speak at the amazing SABRA Operator’s Conference and catch up one-on-one personally, and we intersected again about future possibilities that we believe are plausible. What I have always loved about Dr. Thomas is that he expands our minds like very few others can do, and we were supporters, and preferred locations for his Bus Tour across America on aging, which was a needed game changer in so many ways!

He gave his usual thought-provocative interactive talk to a room of great operators, so I wanted to share my interpretation of his most current message about the aging care future, senior housing hopes and needs, caregiver experiences, his view of life, tiny houses and true independence as defined by Bill.

Dr. Thomas started with one question that he believes defines our current and future success or failure: “What is optimal independence for your customers defined by highest autonomy possible that we can provide and get them to their preferred place of choice?” His question is hard for the traditional nursing home crowd but we get the point because at Signature HealthCARE we know we can’t change fast enough!

He sprinkles in the famous Dutch quote, ”We take care of them by turning our back on them (which can maximize independence) as way to reframe what is compassionate care just to stretch the audience a little verses optimal independence.”

Here are his Top 20 future visions for all of us to consider as potential mental modes to innovate around:

  1. We must establish Network Value over Brand Value defined by how many and what volume of nodes has your organization activated? (Airbnb vs Hotel Names)
  2. It is the slow end of Licensing Revenue related to revenue guaranteed and related to healthcare designations such as SNF, IRF, LTAC, etc. replaced by universal network of care transitions.
  3. Get out of the nursing home business because there are no profits, too many regulations and too big labor shortage and start to deliver age-friendly acute care as fast as you can.
  4. Don’t test regulations in micro ways or name them your constraint – do the opposite and exploit them by going far enough that they don’t transfer so you can get the room you need to innovate.
  5. Alzheimer’s won’t get cured in our lifetime but the incident rates will drop steadily due to exercise, diet, and better understanding of wellness, so incorporate prevention in your vision.
  6. Food is the real story and the second biggest thing – own it, spend time in it, change it, think about it 24/7, make it transformative now – it will be your biggest gain available!
  7. With growing income disparity heading into the baby boomer explosion, there will be a massive shift to flexibility, fluidity, and transferability in personal homes because it is emotional, only real asset often, and new solutions will provide many new options. Start now.
  8. Don’t be afraid of offering housing on site for clinicians in training because segregated age-related living is dying, so add ways to offer housing options to enhance the intergenerational possibilities.
  9. Don’t forget about the bathrooms because we have missed it several times – sacred space that needs to be uplifting, simpler, safer, and therapeutic – start redoing them. Big win potential.
  10. Household linguistic logistics will be the next big thing but we are too late already. Amazon will own it like everything else.
  11. Customer focus needs to be on independence but judged by developmental opportunities, physical and mental strength services, and wholesome belonging.
  12. Innovate healthcare advance directives and personal choice early with full transparency and consider an added value service because it really matters.
  13. Reduce compassion because it can build too much co-dependency. Dr. Thomas believes we do too much and give too much – get them doing again even at half the output.
  14. Skilled Nursing is dead because they will never pay you enough so you better change now because we are at the end of an antiquated era of limits.
  15. Universal care workers still will work but it must have a new management model above it or they will kill for control purposes. It must be self-autonomous teams with peer accountability to work.
  16. Most of you have 50% turnover because employees have much better options to consider now and you must change your options in all ways to compete.
  17. Home health is the big monster going from the hang your shingle, buy your van with magnetic tag, and passing out brochures as small operators, to a roll up phase ending soon to the most networked powerful healthcare delivery system in the world.
  18. Automated assistance will have a big impact through digital support, artificial intelligence voice interface, and tele presence robots that are becoming affordable but don’t believe the hype on sensors because too evasive and limited use in the end.
  19. Understand that the baby boomers are four groups in one. Watch Latitude Margaritaville development – who wants that kind of a waiting list?
  20. We are in first phase of senior care deconstruction in many ways that requires capacity reductions due to obsolescence, the need to establish new independent consumer-directed networks, reduction in pre-determined paths linked to regulated licenses, and new ways to operationalize the home.

You never have to agree with all of Dr. Thomas’ Futuristic Predications because he wants to push the audience to where we are all uncomfortable — which he has mastered — but there is real invaluable insight into how much change we need to bring to our own worlds to be here next decade.

Many of us in the crowd would love to try it all but we are all too busy trying to meet payroll, stay open and be the best version of ourselves and survive the day!

I never believe our post-acute care facility business is dead or over but I know we have to change faster sooner than later, embrace the discomfort he brings to the conversion and self-reflect on his ultimate question: Are we providing the optimal state of independence for our customers as defined by Dr. Thomas?

Thanks to Rick and the amazing Sabra team, we loved the conference!

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