Residential Assisted Living By Design

I was speaking with this individual who actually became a client and her story really intrigued me. She’s found tremendous success in the United States helping people in the residential assisted living space and bring their properties up to another level. Because what everyone talks about is location, location, location. When it comes to buying real estate, well, it’s also about making it attractive to people. Set yourself above your competition, make it so that when someone comes to your property, they want to retire in your property.

She’s developed a business around that, helping residential assisted living owners take their properties to the next level. The person I want to introduce to everyone that is listening in right now is Lisa Cini. Lisa, thank you for being on. How are you doing this morning?

Lisa: I’m doing fantastic. Thank you for so much having me.

Clint: That’s great! Where are you at right now? Because I know you travel all over the place.

Lisa: I do! I happen to be in Columbus, Ohio today—in my hometown. I feel very blessed to be sitting here instead on an airplane.

Clint: Yeah. People often ask me, “Clint, where do you live?” I tell them, “Seat 2C on Alaska Airlines.” I know you’re kind of the same way with all of your travel. 

Lisa: Exactly.

Clint: As I start out the show, we’re talking about your business, before we get into that, maybe if you could everyone a little bit about your background and how you actually got into this space because you just don’t fall into a residential assisted living?

Lisa: No, I don’t think you do. Somehow it happens to you, but you didn’t realize that it happens. I am an interior designer by training. I did a little bit of residential design and then became a commercial designer and then certified in health care. I went to work for a hospital system and actually did construction management and some very clinical medical equipment development. What I found was that we were sending people home in three days for open heart surgery and that didn’t sit very well with me.

I looked at how I could impact folks that needed help from a design standpoint, but also health care standpoint, and senior living was a perfect fit. That was about 25 years ago. I went to work at a company called Karrington Senior Living and we had properties all over the US. We went public, we bought other companies and then we sold. 21 years ago, I started Mosaic Design Studio to be able to help other folks around the country, North America—actually all over the world—get into this game of senior living. That’s pretty much how it happened.

Clint: You saw a need that people are going into these properties, they don’t want to, I would assume, go down in their standard of living, that you want to make it comfortable for them, you want to make it nice and attractive. When my grandmother, before she passed, one of the things that she was dead set against was going into the nursing home. Basically, to her, going into that type of facility would mean that you were going to die. When she went into the home, I think she lasted about two weeks and she just gave up on life. Would you say that what you’re doing is trying to make this a comfortable transition for people and that that’s what they should be doing with their properties?

Lisa: Most definitely. When I started in senior living, we had an average stay of two years. Now, I’m seeing people staying up to 20. It’s a completely different mindset. Folks like your grandmother, for instance, would go in when it was a crisis situation. At the very end, there are two things you didn’t want to do: you didn’t want to go into nursing home and you didn’t want to go into the hospital because you weren’t going to come out of either those situations.

I think assisted living in the home model which, when people think of assisted living now, they think of Brookdales and Sunrises and these very large corporations that might have a thousand rooms, they might have 200 bed at the minimum—those types of things. They forget that the residential assisted living model of today is really where senior living started.

Clint: How so?

Lisa: When I started out, we were doing homes for 12-24 people.

Clint: And then they just took it, scaled it up.

Lisa: They did! They scaled it up partially because of profit in FTEs. It became a very big publicly traded thing and then you’re trying to report to Wall Street instead of focusing on your mission.

Clint: Yeah. The proverbial, “Bigger is better,” maybe for the bottom line, but it’s not for the person, the senior that’s going on to that home.

Lisa: 100%. When we started scaling up and making our homes for 150 people, I would ask my grandparents to come and look at them, not because I wanted them to stay there. They were private pay; we didn’t even have the money for them to stay there. They would not even go and look at one of the properties that I had designed because they were scared to death that we are going to trap them there.

Clint: Yeah. No doubt. That’s the way my grandmother thought. Just that little tidbit right there, for the people that are listening that are considering starting residential assisted living or currently in the space and they’re designing out their properties, who do you bring out to determine whether or not this is a property that people want to reside in? Your grandparents, your parents even—if they’re alive—bring them out and say will they be comfortable staying in that type of property. That was pretty astute to go right to the people that you’re targeting and see what they thought.

Lisa: Yes. The second book that I wrote was called Hive. It was about the social experiment that we had. I moved my 92-year-old grandmother with Alzheimer’s and my parents in their late 70s in with my two teenagers in high school and my husband. For 4 1/2 years, we lived together. I experimented; I got to do all kinds of things that a lot of my clients wouldn’t allow me to do and see what worked and what didn’t work. Partially, I did this because I had kids going to college. How was I going to afford private pay senior living for three adult folks? But also, you got to walk the walk and talk the talk.

When my grandmother was going through that, I said, “Grandma, it’s like a home. You don’t understand how beautiful these places are and how wonderful they are.” She said, “Lisa, do I have to put my makeup on and do my hair when I come out of my bedroom or unit?” I said, “Yeah. There’s going to be a lot of other people.” Then she said, “Then it’s not my home.”

Clint: I could see that.

Lisa: I thought that was just a wonderful, we say it’s ‘their home’, but in reality, if you’ve got to get dressed up to go outside of your bedroom door or you’re going to be embarrassed about yourself, it’s not your home. As much as we try to make it, that’s where I think the residential assisted living communities and the small house type is so needed right now because it still is a home.

Clint: How are you going to be on that mindset though? Because if you’re living with 15 other people, how do you become comfortable enough, I guess for a person like that, to make and feel like this is their space, so they can go out right from the bed to the breakfast table and not worry about that?

Lisa: That’s a great question. I think part of it is how the staff engages and what kind of things that you do with them. In the small models that we’ve designed, staff eats with residents and family members, being able to really do that one-on-one care and that intimate care versus not knowing who your caregiver is going to be that day or who’s helping you or who is the house person. I think those types of things allow to let your guard down. You don’t see a ton of random people coming in because there’s not 150 residents, times 3 family members, times 6 caregivers.

Clint: It feels like your surrogate family then that you have there because of the way it’s set up.

Lisa: 100%.

Clint: Great. You talk about residential design that you’ve gone in and you’ve probably seen a lot of issues that keep […] aware of and maybe they’re struggling with their properties. I like to get your insight on that, but we got to take a quick break. When we come back from the break, let’s talk about those issues that you’ve seen and how you’ve may be offered solutions to that?

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Clint: Welcome back, everyone. Hi, it’s Clint Coon of the Anderson Business Advisors and on the podcast, they were talking to Lisa Cini about residential assisted living and designing properties. Right before the break, I asked a question of her about some of the things that she’s seen when it comes to current properties—that’s when she’s gone in and seen issues and how people have improved that by improving their properties with her assistance.

Lisa, can you tell us some stories? I imagine you have many, many that you’ve dealt with in the past where you’ve got into a house and you look at it and you say, “Alright, this is why you’re not finding success.” Or, “Why people aren’t having that feeling like you were talking about of this is my home.”

Lisa: Right. I’m so glad that you brought that up. Because I think that quite often, we confuse with great care and great food that it’s going to be easy to fill a home. What people forget is that you’ve got to reduce the barrier to entry. As I was talking about before, you’ve got to make people feel like this is not a place they’re going to die; this is a place they’re going to have the burdens relieved from them so that they can really thrive.

The mentality has to be very different. You have to move them from fear to freedom. They spent the last couple years disengaging more might have been the death of a spouse, it might be some memory issues, it might be that they’re not driving any longer, but they’ve had their freedoms taken away and they’re sitting in a place of fear.

You have to counteract that. One of the ways to do that is to look at spa design. When you go to a great spa, they are all about getting you from fear to freedom in being able to enjoy your massage. Clint, have you ever had a massage?

Clint: Once.

Lisa: Okay. A lot of guys don’t enjoy it.

Clint: No, we don’t.

Lisa: No but most females do. The reason why most females do is because it is a nonsexual touch that is very therapeutic and it’s a very nice thing. But how do you get someone from the moment they enter the door, to be lying on the table naked and having a stranger touch them? That’s a pretty big gap. Wouldn’t you say?

Clint: Oh, yes. Especially if you’re a woman and it’s a man coming in. I could see that.

Lisa: That’s exactly right. That’s not that different than trying to get someone to come into in ageing place, a residential assisted living or just a regular assisted living. They’re going to be basically be in 100% vulnerable. They might be even having someone help them with dressing and eating and toileting and those types of things. It’s very similar spa design. The first thing that any good spa will do is the exterior says, “We’re going to take care of you.” If your landscape is not well-appointed and taken care of, that tells me how you’re going to take care of me in an intimate way.

Clint: Curb appeal.

Lisa: Curb Appeal. 100%. If I don’t feel comfortable coming into that home, opening that door, how are you going to take care of me in the big things as how you take care of the little things.

Clint: Okay, with that idea right there. When you say, “We got the landscape.” And then when you open up that door, what is the first thing people should be greeted with as far as should there be a foyer. When you’re designing the house out, let’s say I got this structure, and I’ve taken it down to the studs and I want to design something that’s going to be appealing. What do you recommend? Should it be like a normal house or should it be more open when people first brought in or open that door?

Lisa: The biggest mistake that I see is in the Sunshine states. They have a tendency not to put vestibules in. They’re like, “Well, we don’t have the same kind of weather. It’s the Midwest or the East Coast,” or those types of areas. What they miss the point of is that that is a permission-based thing. When you open the door and you enter the vestibule, you’re able to get yourself set, get comfortable, maybe check out your lipstick or fix your hair from the wind or whatnot, before you choose to go through the next door, it is a decision-making process. That person that comes through the next door, they’re able to see what they’re going to go into before they go into it, and properly prepare themselves and get themselves together.

It’s a stage in saying yes. That is a very, very big thing. It also helps with any kind of weather. To be able to make sure that the inside is a comfortable temperature and you’re not fighting the elements. Whether it’s rain or dirt from the sidewalk or the street, or heat or cold. A vestibule is critically important.

Then when you come in, if you think about your home, you should have a space that’s like a living room where you can have hospitality. But you’re not walking into somebody watching TV and feeling like you’re going to walk in for the TV or disturb someone. You would never do that in anyone’s normal house. You have the entry living room where it’s where you greet people and you’re able to get comfortable. And then if they’re appropriate, you invite them into the more familiar spaces or family room or dining room.

Clint: Do you strive in your designs for a more open concept than for main floor?

Lisa: I think open concepts are great. I think they cause a little bit of issue. You need to have it open enough so that it’s easy to move around and that folks don’t feel cramped and they have dual entrances and exits out of spaces. But you don’t want to be able to see everything right when you walk in. You want to be able to discover the space.

Clint: When you’re designing a property, do you like to have a lot of hard surfaces or is there a certain combination people should strive for between hard and soft?

Lisa: That’s a great question. Typically, most seniors have hearing issues. A lot of people are putting hard surfaces everywhere. It’s easy to clean and take care of. A problem with it is, it’s way noisier; it becomes disturbing. It also is harder on the body if somebody falls.

Clint: Yeah. That’s what I would imagine. But at the same time, is it not then more difficult if somebody needs a walker or some type of assistance over carpets?

Lisa: That’s a great question. Typically, we will do a very, very low pile, very, very dense carpet. What happens with that is it helps to absorb the noise quite a bit because what I’m seeing now is a lot of vaulted ceilings which also add to the noise issue. The low dense pile carpet is very easy to walk over, it’s not a high residential carpet. It’s also very, very easy to clean.

Clint: Yeah. Because anything that spills on it typically stays on the top of the carpet and it doesn’t absorb really quickly.

Lisa: 100%. When I was a designer in the hospital system, we actually did a lot of studies around this. We put in carpet into certain clinical areas. What we found, number one was germs don’t jump. Everybody thinks germs jump, they don’t unless you’re rolling around on the floor, you know, you won’t catch a thing. But the other thing was that people are much happier with the reduced noise and it requires less amount of time to clean carpet than it does to clean a hard surface.

Clint: That’s interesting. Yeah, you’re right. Because you can just vacuum it rather than having to get down there with the mop or water.

Lisa: Yeah, that’s exactly it. If you do the right carpet and that’s part of it; if you do the wrong carpet, it’s a loss. But if you do the right carpet and have a designer that selects that and it can still look residential, it really is a win. Now, in dining rooms, it’s a mix. Some people do carpet a very dense, moisture barrier carpet in the dining rooms. Other people go to the LVT, the luxury vinyl tile that might look like a wood plank or such. It really depends on what you want to have, but understanding the acoustics is critical.

If you can put an induction looping technology. What that is, is it’s a wire, it’s been around forever, but it’s a wire that goes underneath the flooring, it’s fairly cost effective. You can hook it up to the TV or a mic system and all the noise, if they’re listening to the TV goes directly to their hearing aid. If you’re playing bingo, it goes directly to the hearing aid.

Clint: Wow.

Lisa: Yeah. You don’t have to have the noise up at 50 decibels for Bob because he can’t hear the game and annoying everybody else.

Clint: Or you do like what we do with my father’s. We have these Bluetooth headphones we just put on him.

Lisa: That’s exactly right. That’s another solution for it. The reason why we bring up the induction looping is because the people who already have hearing aids, a lot of times they don’t want the use the Bluetooth headphones, but it really helps. The other thing that I would say from a design standpoint that I see as a major mistake is that there’s not enough lighting.

Clint: I could see that have been really important for people. When you’re picking out lighting, is there a certain type of, I mean, we have cans, we have fixtures, we have tracks, it just depends on the room itself or do you find that there’s one lighting that tends to be better than others?

Lisa: We like indirect lighting the most. Indirect lighting means, it’s shining up on the ceiling, you can have an indirect up and down, but generally we prefer indirect shining up. We’re doing them now in crown molding and it’s pretty cost-effective to do that now with how inexpensive the LEDs have become. It used to be pretty expensive; it’s not near as expensive now.

It’s a much more consistent light level, you can make it color corrected, you can even tie it in with a circadian cycle. I don’t know if you’ve been on one of those airplanes, JetBlue and some of those Virgin where they actually have the sunrise, the daytime and sunset which helps to set your body so that you sleep properly. That’s also a selling tool.

Anytime we can, we try to avoid can lights or downlights. It’s not what you see in any home. It shines down on the face. It makes people look a little bit like a scary Halloween movie versus lightening up the space and making everybody look great.

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Clint: What about furniture then, as far as sofas, chairs, things like that? I would imagine, you wouldn’t want someone that’s going to be where people are going to sink into it, do you want larger or smaller?

Lisa: That is a great question. A lot of times, especially when you’re doing a residential, you don’t necessarily have to meet code in some of the models, depending on how many residents or folks you have. What we do is we specify residential furniture, but we build it to commercial standards that meets all the fire codes. It looks residential, and it’s built by the residential manufacturers, but we make them change out the foam density on the interior so that it’s a little stiffer, but not harsh so that you don’t sink in and you can get in and out of it more easily. You can become more independent. We’ll find a lot of times people will be using walkers or canes when they come in and when they get the proper furniture, they can get rid of this.

Clint: Because they can get out of it without any problem whatsoever.

Lisa: Exactly. When you feel like you can take care of yourself, your spirit rises.

Clint: Yeah, absolutely.

Lisa: You’re a happier person.

Clint: When you’re thinking about design in the property, a lot of times, I would imagine people have this preconceived notion of, “Oh, it’s going to be restoration hardware throughout what she’s talking about. It’s going to blow my budget. I’ll never be able to recoup my investment into this and the designers are really expensive.” How do you confront someone that has that preconceived notion or what do you say to them?

Lisa: One, we buy wholesale. We get discounts that are better and typically half of maybe even 60-70% off. We don’t sell anything. We charge a fee—not every designer does that—but we charge a fee to procure for you. With our fee and our discount structure, we buy better than you could even buy wholesale. Number one, you’re winning just right off the bat. Two, these pieces of furniture are going to last you quite a long bid of time and they’re not going to be retail prices because I don’t even buy a retail. That scares the heck out of me. I think the prices are ridiculous.

But being able to custom design them and sell that, if you don’t fill fast, it kills your proforma. I’ll find that someone comes in and they’re not filling—and it’s either a lighting issue or a furnishing issue—it just looks like someone hasn’t chosen everything well. I’m choosing to seat height, the seat depth. Typically, too, we’re doing seat heights that are 19-21 inches high. That’s almost impossible to get in the residential furniture. But again, it improves dignity and independence.

We have arms on everything. We’re making sure the fabric might be a Crypton fabric so in case someone has an accident, you don’t have to throw it away. It can just be cleaned and it’s a-okay. It’s going to meet all the flame codes which helps with your insurance to be reduced. There’s a lot of wins.

Clint: If I, say had a house, I just bought this property, and I’m looking to design it or get it set up for a REL, if I wanted to engage, you engages people that are in Arizona, Florida.

Lisa: We work actually all over the world. We’ve done a little bit in China and Italy, quite a bit in Canada, and then everywhere in the United States.

Clint: How does that work out. If I’m in Florida, do I send you pictures then you create a design for me? Or do you actually come out for […]

Lisa: Sometimes. It really depends. Sometimes we come out. We’re in Florida constantly. I’m in Arizona quite a bit. I’m in Texas quite a bit. There are certain states that are hot at different times, but Florida, Arizona, Texas, those kinds of states, California, seemed to be hot all the time. If the property is big, we might fly down and actually do a Matterport video, which is a camera that takes 360 photos and then stitches them all together and then our team is able to go through and design the whole thing from our offices. That’s how we do the majority of our projects. Then through Zoom call, but some of our clients want us to come in person, otherwise we can do it completely virtually.

Clint: Beyond just the property itself—the interior, the paint colors, the carpeting that we’ve been talking about—you also have talked to me about technologies that you think are essential for this space and as people get older. Maybe you can spend just some few moments touching on that as well and explain into the listeners why this is another aspect that are oftentimes neglected or not even thought of.

Lisa: Yes. I attend a lot of futurist conferences and then I’ve written a book on technology and senior living and then Hive and then BOOM which is my latest book for baby boomers in technology. What I found is that especially in private pay, high end, big senior living, not the residential assisted living. But those guys were ignoring the technology that was out there and when Lowes and Amazon and Home Depot are getting in your business, which they are, you’ve got to wake up, and you’ve got to start providing what the residents want.

One, you have to have enough WiFi in all the bedrooms and in the common areas to stream a live football game—that’s number one. People are like, “What do you mean? We have WiFi?” No, no. Once you can stream an ESPN game live, you don’t have proper WiFi. The reason is, is you’re not going to get the family members to visit especially the son.

Clint: That makes sense, yeah.

Lisa: Mom doesn’t really necessarily need to talk to her son the whole time, she just wants him to be there.

Clint: I know.

Lisa: She just wants him to be there and then she wants to brag to everybody how her son came. It’s a huge win to be able to have that. And then be able to connect whether it’s FaceTime or doing game application, where you’re playing games to help your brain or whether you’re just getting on Facebook. That’s the big one.

The next one would be the technology bidet toilet seats. We try to put these in on all of our projects. This is not like you’re thinking. If you’ve ever been to Europe or Japan or whatever and there’s a bidet toilet seat where it’s a separate toilet without a toilet seat on top of it in that in a crude way basically, you go to the restroom and then you transfer naked essentially to a toilet that you hover over that has a hose to it to clean yourself off. What they’ve done now is you can actually change out your existing toilet seat with a bidet toilet seat. It’s warm, it’s antimicrobial, it’s antibacterial, it’ll spray you off and clean you and blow dry you.

Clint: Wow. I imagine that makes some people uncomfortable though.

Lisa: You know, some people we have found that the majority of people think it’s awesome once they try it. We even have them in our memory care homes. Family members love it, and the residents—when they’re cognitive enough—love it because that’s an intimate thing, that’s being very vulnerable. It’s much healthier for you. If you can have someone utilizing a technology like that and they are able to maintain their dignity and your staff doesn’t have as much of a burden on them, that’s a huge win and that’s like $350.

Clint: Well, there is your next birthday present or Christmas gift for a relative.

Lisa: 100%. That would be some of it. Some of the other technologies are not necessarily things that you plug in. Everyone thinks that technology, you have to plug it in, but the technology is really just a tool. There are grab bars that are built into these toilet paper holders. What that does is it […] exactly where you need to grab to get your center of gravity to independently get on and off the toilet, which is another huge dignity issue and can be a burden for staff. Having that in every single bathroom is an enormous win and that’s $40-$60 and it holds up to 500lbs. You don’t have to have blocking so it can go into an existing condition. It’s just a huge, huge win. It also tells the people that are coming into your home, we care.

Clint: Yeah, exactly. You wrote that book, BOOM: The Baby Boomers Guide to Leveraging Technology, so that you can Preserve Your Independent Lifestyle & Thrive. The thing that you talked about that discusses this ageing solo, talks about pets, which I understand now is huge. I just read something in the Wall Street about this not too long ago, how people respond when pets come.

In fact, I was talking to a buddy of mine whose father was in a senior care facility. Many of the people in this facility are suffering from Alzheimer’s or Dementia-related issues. But of the things that they notice is that they would bring in these dogs, comfort animals, and everyone in that facility would always remember, they knew the comfort animals come in there when they tell them and they would all get dressed up, some guys would put on suits, they’d wear nice clothes just for these animals to come and meet with them. They said it was always the highlight of the week when they bought the pet service.

Lisa: It is huge. What we’re seeing now is quite a few people are asking us to put in a pet shower, bathing area. Because that’s one of the biggest issues is, “How do we take care of the pet and bathe it?” It’s up high so you don’t have to bend down, it’s wide enough and it’s just back by the laundry room. But being able to say, “We understand that we love your pet, and you don’t have to give up your pet,” is huge.

Clint: Those little things that unless somebody has been in the industry as long as you have and helped design these properties, if they’re just getting started or maybe they’ve been doing it for a few years and are wondering why they’re not finding the success, it’s because they don’t know these stuff.

Reading your book, which you can get on Amazon, I saw it on Amazon as well. Look it up, you guys are thinking about space, and you want to get involvement, definitely grab her book. It’s BOOM: The Baby Boomers Guide to Leveraging Technology, so that you can Preserve Your Independent Lifestyle & Thrive by Lisa Cini, it was really simple for me to find by typing it in. You’re going to gain insight into how you should be putting your properties together. It doesn’t mean you have to adopt everything that’s out there. But some of the small things that you’ve just brought up, I could easily see someone going in and making some minor tweaks. It could really help boost the number of people that want to stay there.

Lisa: Yeah. I think so. I think it’s a huge thing to understand. I really didn’t understand how much pets were until I started writing the book. I actually had one of the top veterinary doctors in the nation to write a chapter on it. Quite often people are spending more money on their pets than they are on themselves. They always love you; they don’t argue with you, they don’t leave the toilet seat up. There’s a bunch of wins on this.

From doing that, I think that was a big aha for me and then the co-cannabis thing was a big aha when I researched the book. I think if people don’t understand pets and where boomers were coming from on cannabis, they’re not going to be able to really have an open mind and be able to talk to people about the flexibility of their home.

Clint: That’s great. Now, people that are listening, if they want to contact you, how best should they contact you?

Lisa: The best way is to go to my website which lisamcini.com. There’ll be an area where you can click on and contact me, and I’d love to chat with you.

Clint: Great. I know you’re probably get inundated with individuals wanting to follow up with you—and that’s going to be perfect—I’m going to have all of you contact information in the show notes. If you’re listening to the podcast while you’re driving and you want to contact her, don’t worry, just go to the show notes, you’re going to have her web address in there, you’re going to have a few of the other sites as well that I would encourage you all to look at to get a feel for what she does. It’s extremely impressive when you look at the properties and the way she designs them. As Lisa was saying, it doesn’t have to break the budget in order to put together a property that’s going to attract a resident. Lisa are there any final parting comments that you like to leave the listeners.

Lisa: No. I think the only thing is if you want to research a little bit of tech, you could go to my bestlivingtech.com website. Just getting something in there and showing people that you are and that you’re moving forward instead of moving backward will exponentially help you to stay full.

Clint: Great! I know you’re so busy. I want to thank you for taking the time out to share this valuable information with our listeners. I wish you the very best going forward and hopefully, we get you back on soon.

Lisa: Yeah, thank you. It’s my pleasure.

Clint: Alright, Lisa. Take care.

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