On golden years

Speaker 1 [00:04] When considering putting a family member in a care facility, I think location to family member was one of the prime considerations. The ability to visit regularly and, of course, the quality of care, and the amenities were also important. Cost is for sure an overriding factor and I think really thinking about how the family would be able to continue to engage with our loved one there, was paramount.

Speaker 2 [00:35] Well my family is in the US, and my wife's family is in Portugal, so location is the main consideration. I'm always thinking about, as my parents are getting older, what I can do from over here so it's a concern, but I don't really think about it necessarily.

Speaker 3 [00:56] I've got a grandmother who's still alive, who's probably in her late 70s now, and she does mention what facilities she would like to go into, and it's somewhere that's local to her. I think location is the priority for her, and with in terms of cost, it's something she seems to think it's her responsibility.

Mariam Sobh [01:21] What is the first thing that comes to mind when you think of senior living? Is it the classic image of Shady Pines from the Golden Girls or is it the image of perfectly quaffed seniors smiling around cups of coffee and golf carts? Whatever comes to mind, I think it's safe to say that the landscape of how and where seniors live in their golden years has really changed, and evolved across the years. With baby boomers marching towards seniority, their demands will upend, shape, and influence the offerings for senior housing, for generations to come. As people decide to stay in their homes, move in with relatives, share a home with friends, or move into dedicated housing for seniors, the choices are vast for those who have them.

How do we define senior living? According to the UK charity, Age UK, it's aimed at people no younger than 55 to 60, who will live in self- contained flats, which have communal socializing areas, and a 24 hour staff. Additionally, this housing can be rented or purchased. In the USA, according to a 2021 survey from the American Association of Retired Persons, or AARP, titled Home and Community Preferences Survey, 77% of adults over 55 want to stay in their homes for the long term. In the same survey, 90% of adults over 65 want to stay in their homes as they grow older.

What will it mean to our built world as more baby boomers decide between staying in their homes, or selling them for an easier life in a senior residence? How will senior living facilities meet the needs of the new seniors, their families, and their demands? I'll address all this as I talk to Iain Lock, principle and managing director, healthcare, healthcare sales, and leasing senior housing at Avison Young, and throughout this episode, Dr.Stephen Golant, professor at the University of Florida and author of Aging in the Right Place. I'm Mariam Sobh and this is Changing Places. Let's hear from Dr. Golant.

Stephen Golant [03:25] I think that, arguably, one of the most important decisions that a person makes as they approach retirement, and later on when they approach a very old age, is where to live. All kinds of evidence suggests that it's easier, and more successfully, possible to age in a place that is compatible with one's lifestyles, and one's capabilities. In my own work I've suggested that where people live have influences what I call residential normalcy, and it sounds rather academic, but it's actually a very simple idea. And it's the idea that older people feel congruent with where they live, when on the one hand older people feel congruent with where they live, when they feel that they are competent, that they're in control, they're calling the shots, they decide who their friends are, they decide where to go. When they feel this kind of competence and autonomy, that's a very important second part of residential normalcy.

Mariam Sobh [04:28] In order to understand how we got here, I'm going to chat with Iain Lock, principle and managing director, healthcare, healthcare sales, and leasing senior housing at Avison Young. Throughout this episode, we'll also hear fromStephen Golant, professor at the University of Florida about the current state of aging and place options for seniors. Iain Lock, welcome to Changing Places. Iain, I want to start by asking about the current state of senior living in the UK and how this senior living is either meeting the needs of seniors, or even perhaps falling short.

Iain Lock [05:01] Yeah, I think the first thing to say, Mariam, is that I think we have to define in the UK what senior living is, because it means a lot of different things to a lot of different people and its got lots of different words wrapped around it. Overall, senior living in the UK pretty much means anything for those that are probably 55 years old and more. The majority of the market thus far has been a model without any element of care within it. We call that sheltered housing, and that purely is a house building model. The only element of care that the elderly within that will get is a monitoring service that they can pull a cord if they need some help, and that's the end of it.

The burgeoning sector is the housing-with-care part of senior living, which is where hospitality and care packages are all rolled into the program for people that are living in those facilities. And that sits very much in the middle between the sheltered housing sector, and care home sector, which is 24 hour care regulated, and for the very elderly in the UK. We have this piece in the middle, which is a really interesting piece of senior living, which we generally call housing with care, although it's got a number of other names, independent living, assisted living, extra care, I could go on, there are lots of names for it.

Mariam Sobh [06:19] Here in the US, the assisted living situation, we have everything from gated golf courses to assisted living in the US. From what you're seeing, is it the same in the UK? Does it look different?

Iain Lock [06:30] It's less big, I think is the first thing to say. In the UK we have schemes from single block, 60 to 80 apartments through to villages of up to 250, 300 apartments or houses. So we can have anything from a small urban development, or maybe an acre, an acre and a half of land, several floors high through to 10, 15, 20 acres with housing and apartments and all of the communal facilities spread within it. We don't have those big resorts that you have in the states. Maybe that's because we don't have the weather to be sitting on a golf course all of the time. But we have moved a little bit into that direction. We do have an element that is called, what I think you call the continuing care retirement community, which has everything from independent living all the way through to a care home somewhere within its design. But I just don't think we won't get to those huge communities that you got to, I don't think.

Mariam Sobh [07:27] Historically who have senior living centers catered to? And have you seen any changes in that? Have they doubled down on the traditional customer?

Iain Lock [07:34] Well as I said, the outset much of the sector was very much the sheltered housing market, which is entirely independent, with maybe just a monitoring system for residents. I think a lot of the market has now moved on from that and said that actually there is this intermediate piece between sheltered housing and full care home, residency and deliverance, and that's the piece which the market is now very keen to look at and is growing the most substantially in the UK. And it's a piece from the residents point of view, where there's much more confidence in being able to stay in that last own home for the rest of your life, rather than staying either in your former family home, or moving to sheltered accommodation, and then needing level of care that can't be provided, so you end up in a care home situation. The market has definitely moved on, and it's moved very much into this housing with care sector.

Mariam Sobh [08:29] What you're seeing in the market now, Iain, who do you think senior living is appealing to? Are we seeing more people 55 and up, or is it still a much older demographic?

Iain Lock [08:40] It's an older demographic for sure. Very, very few people between probably 55 and 70 are really thinking about leaving the family home and downsizing. I think the sheltered housing market is very much a 70 plus market. Housing with care is certainly 75 plus and in many instances it's 80 plus. And if you look at the average age within mature schemes in the UK it's probably around 83 to 85 years of age, as a mature scheme. People having moved in probably late 70s and have aged in situ.

Mariam Sobh [09:13] You mentioned earlier that the UK doesn't necessarily have these huge sprawling retirement communities. I guess they're like resorts. How would you say owners of senior living centers would go about creating something that appeals to people who are still very active, that like that resort feel where they feel like they're back in high school? How do they change the impression of that versus going to a care facility, where you're just kind of parked in front of the TV all day?

Iain Lock [09:43] I think the operators are working very hard on that, particularly with regard to the hospitality offering that goes with a village, or a large urban scheme. It'll have a restaurant, and it'll have bar or cafe, it will have concierge, it will have a wellness center, that might be a wet spa, in some instances to the upmarket schemes. They are providing all of that to say to people, this isn't just a place where you receive care, this is a place where you can have interaction with like- minded people. This is a place where you can have leisure time. It's a place where you can stave off that loneliness that you feel in old age. As and when you need an element of care, we can layer up care packages for you, so that you are not in full-time care, but you have visits during the day according to your needs.

If you've been in hospital and come back out of hospital, it may be a package that has to step up for a while whilst you are in rehab, but then it steps back down again when you're back living a normal life. They're working very hard at that perception in the marketplace, and I have to say, it's been quite difficult for them. It is quite difficult when you have a limited number of schemes in the UK, but as that improves, so the demand is increasing, and people are beginning to understand that it makes sense to make this move perhaps a little bit earlier than they would otherwise have done.

Mariam Sobh [11:05] Iain, I want to know what you think about how senior living centers are shifting to appeal to baby boomers? We'll get to that in a moment, but first let's hear from Dr. Golant.

Stephen Golant [11:14] There's a one alternative called a continuing care retirement community and it has multiple levels of care, what they call independent living. It's a very expensive alternative because you often have to pay a very large upfront fee, along with a monthly fee to occupy the place. Here we find a small sliver of the older population. The continuing care retirement community, independent living section or a level of care. They tend to go a little bit earlier.

Now the other exception is a whole different animal and that is of course what we call the active adults community, the sun cities, the leisure villages, they're selling not a level of care but a quality of lifestyle. If anything, they want to live vital, active and stimulating lives. And so everything from tennis to pickleball to financial planning to all kinds of activities, and swimming, and golf, and all the rest of it, proves an attraction. But you have to understand the experts are very divided even on the desirability of this alternative. There are some experts who say, oh, older people wasting their lives. Why are they going in their late 50s and early 60s to live a hedonistic lifestyle? Oh my gosh, they're having fun, they're enjoying themselves. They work their whole lives and they say, I don't want to volunteer, I don't want to give back to the community. I want to have fun.

Mariam Sobh [12:47] Stay tuned for the next part. And just a reminder, Changing Places is a podcast brought to you by Avison Young that continues to explore and question our complex relationship with the built world around us. I'm your host, Mariam Sobh. I hope you're liking the show so far. If so, please share Changing Places with your friends.

Welcome back to Changing Places. Before we get back to my conversation with Iain Lock, let's go back to London to hear what folks there think about senior living.

Speaker 3 [13:20] I think everyone should have access to good healthcare for free, and if people have more money and want to upgrade to more of a private service, then I guess I don't see why not. But as long as the minimum of baseline is really good for everyone.

Speaker 4 [13:39] I think governments do have to take quite a big responsibility, especially as we have such an aging population and also because healthcare's been devolved to sort of private care for people who are elderly. And originally the NHS was supposed to look after people from the cradle to the grave and they don't do that anymore, haven't done so for a number of years.

Speaker 5 [14:11] Thinking about what my family would do and I guess the situation so far has been with my grandmother. And when my grandpa died, whether she'd go into a care home or something like that, she didn't want to leave her own house and things, and have her independence, but she had dementia. I think cost was a massive factor. But it's assisted living, sort of thing, where she has her own flat but she has care people around. But the cost of those things is just a lot. So I think in home care is what we kind of looked at so that she can stay in the same place, but it's getting someone that's consistent.

Mariam Sobh [14:49] Now back to my conversation with Iain Lock, an expert in senior housing from Avison Young. With things changing, now we have baby boomers, who are possibly beginning to inhabit some of these care centers. Do you see that this is an opportunity for owners of these centers to maybe make some changes or is it disruptive to an established business model?

Iain Lock [15:13] There are a lot of facilities that provide little in the way of hospitality or care, which are built in a way that probably can't change. They are what they are. They are of their day to some extent. And so those who have owned and are in developed facilities like that, tend to be morphing their business model through the development of new facilities. And they're doing that by increasing the front of house. They're increasing the communal facilities and the restaurant, bar offering and the games room and all of those things. And so they're doing it in that way. It's very difficult to retrofit some of those older schemes that we've got in the UK. And so there is a huge concentration on new development and building today's model.

Mariam Sobh [15:54] So on that note, I'm kind of curious, you mentioned some things like these restaurants, or spas, or things on property. What other kinds of housing options and amenities are being offered to make someone decide to leave their home and move into a dedicated flat or house for seniors?

Iain Lock [16:11] The two things that play off against each other here are, the quality of the accommodation that people will live in, their own apartment, their own house, their own bungalow, whatever it happens to be, and all of those communal facilities that they can share with everybody else. And it's a combination of those two things which tend to come together to make people decide to make the decision to move to one of these facilities. So the quality of housing has to be very, very strong, I think alongside all of those other communal facilities and then outside space, very important to people. The ability to go out into a garden or into a proper balcony. And those things are now being designed into the facilities here a little bit more than they were perhaps two, three years ago.

Mariam Sobh [16:53] When we talk about the financial aspect of where seniors choose to age in place. Before we go into that, I do want to talk a little bit about, for our listeners, what kind of senior living options exist and what that looks like right now?

Iain Lock [17:08] The options are stay in your own home, and move to an apartment in a block, which offers a very limited range of services. They tend to be urban developments, quite close to local shops and so on. Developments of 200, 300 units, which tend to be much more rural, rely more on people either having their own car, or a chauffer, or a mini bus service provided by the operator. And so it's very broad. It's less well developed.

As I said before, in some areas of the country has been more dominant for the development of private housing with care because that's where more of the wealth sits in the UK and it's been harder to provide those full services to the less wealthy population in other areas at the country. The choice varies across this country quite significantly, even though we're a very small country. And I think that will be the case for some time to come because we are going to have to move into other styles of financial model to be able to assist the middle and lower end of the market, I think. And that's something yet to be developed, but it's an exciting area and it's a big area of development if that financial modeling and tenure can be worked out.

Mariam Sobh [18:20] So when it comes to finances, how are most seniors able to afford, I guess these different tiers of care? Is this something that they would have to sell their family home and that's where the income comes from? Are people planning ahead and saving up?

Iain Lock [18:36] No, I think it's probably two newer model for people actually to be consciously in their 40s or 50s organizing their finances for a definite move to these sorts of facilities. It very much comes from the family house, or from pension sources. And generally the majority of the UK model for the private sector is a buy model, rather than a rental model. It is a capital sum that's being looked for and that tends to come from the family house. Maybe some of it from a pension but the majority from the family house and that allows people to downsize to maybe release some cash for distribution around the family and then perhaps putting some aside to help them with the running costs and the service charges of living in a facility and maybe the rest comes from their pension, or state pension. It's a combination, but it's very much driven because it's a private market for sale model. You buy your apartment on the main in the UK. You've got to have that lump sum to be able to do that. And that's why the south and the southeast is where the majority of the operators have concentrated thus far.

Speaker 6 [19:45] I don't think anyone should have to worry about their care when they're older and whether or not they can afford it. I think it should be kind of a basic human right that you know you're going to be safe in your old age and therefore it should be something that the government look after for those people who maybe can't afford it as much.

Mariam Sobh [20:02] So what do you think would be the right move for folks that are listening, that are thinking about the future? Is saving up for senior living something we should be thinking about in our prime? Should we wait until we're in our 70s? What is your thought on that?

Iain Lock [20:18] It's a really difficult question to answer because it's different for every individual of course. I mean, there's no doubt that everybody has got to save for old age, however, you're going to live in old age. The chances of the government looking after anybody other than the very, very poorest in society is getting slimmer and slimmer as time goes on. Elderly people are going to have to look after themselves, I think that's for sure. So I think everybody has got to plan for that and that's going to be pension, I think to a large degree. We now have a generation that we call generation rent, which is probably 35 year olds and younger who can't get onto the housing ladder because housing is too expensive and they don't have a sufficient deposit to put down and then take a mortgage for the other 85, 90%. They just can't find that 10, 15% deposit.

So things will change. And actually this senior living market may move much more to a rental model when generation rent is coming through, but that's 25, 30 years from now. I think those that are sort of 55 plus now realize they've got to look after themselves, they will downsize. And I think downsizing options is where the senior living market, the senior living housing market, really has a resonance. So it's appropriate downsizing for people and there are limited downsizing choices at the present time. So I see that... It's a big market.

Mariam Sobh [21:40] Well, you spoke a little bit earlier about retrofitting old buildings and I think there's maybe a little difficulty in doing that. Are you seeing private investors and developers building new senior living centers as things move forward? Or are they planning to retrofit old buildings?

Iain Lock [21:58] No, it's mostly new build. Retrofit is difficult. It's as expensive as new build generally in the UK, particularly if you're looking at historic buildings, listed buildings, they are very difficult and very costly and often once done, they're still less efficient than new build. So the majority much prefer new build, although one or two operators do like a small old mansion house as a centerpiece to set off the rest of the facility and that can work incredibly well. But the majority is new build and I think that's the way that it will continue to go. There's huge pressure on land in the UK. There's difficulty in getting land for development and the planning system isn't fast and isn't easy in the UK. So there are frustrations around development, but the developers are little by little, they're finding roots through that. And several of the main operator developers now have quite significant pipelines of new schemes coming through the land negotiation, the planning and acquisition and development process. We're seeing it continue to expand.

Mariam Sobh [23:03] Iain, if we look forward, what does the future hold for senior living centers over the next decade or two? Let's discuss that after we hear from Dr. Golant.

Stephen Golant [23:12] Money buy a lot of quality of care. The idea that we can enjoy all the quality of care that we deserve is simply understated. You should make a distinction between three grips of people. On the one hand you have people who can afford those expensive alternatives, and then you have lower income people who are eligible for some public benefits. They can, for example, if they're available, find affordable rental projects that are subsidized by federal program, but they're in short supply, and there's a long waiting list. But then you have the middle income folks, and in many ways they're interestingly disadvantaged because they can't afford most private pay alternatives. But on the other hand, they're not eligible for any public programs. And so they're caught in the middle, literally caught in the middle. They have a difficult time off and finding those kind of alternatives that vaguely would most fit their needs.

Mariam Sobh [24:16] Iain, I'm curious to know what you think the future looks like for senior living centers in the next decade or two?

Iain Lock [24:24] I think it's an exciting sector. I think there will be a lot more of it. I'm convinced that it is a housing with care model that's the right model and that level of care might be low to start with, is capable of being built up for residents as they need more so that they can stay in that own home for hopefully the rest of their lives. I think the nursing sector and the care home market in a similar fashion for the end of life care piece, but I think it is becoming increasingly end of life. And so more people will need care in their own homes and a purpose build. Housing with care scheme is much better at doing that, in delivering that to people with all the front doors next to each other with single floor living with safe environments, keeping people out of hospital, keeping people out of A & E, keeping people out of doctor surgeries.

That all makes sense for the whole of the health economy to do that. And I think, little by little that will get into the consciousness for everybody. I think we do need to see the model capable of being delivered to the mid- market, to those that are too wealthy to be looked after by the government and not wealthy enough to have the very best of schemes and all that goes with it. I think we need to see some change in tenure perhaps for that rather than outright purchase, maybe shared ownership or an element of rental within that as well. There might be other forms of tenure that can come forward, like lifetime tendencies where people pay a lump sum but not the full capital value of the facility and then live in it for the remainder of their lives. So I think we will see those tenure changes. I think we'll see design creep going on all ways. I would like to see it as something which is able to spread across the whole of the country and to be available for everything. I think there's everything to play for.

Mariam Sobh [26:08] Yeah, I mean this topic has gotten me thinking about saving up for some kind of a resort because it's probably going to come faster than I realize. But thank you so much, Iain.

Iain Lock [26:22] It's a pleasure.

Mariam Sobh [26:23] Mariam Sobh: And finally, Dr. Golant.

Stephen Golant [26:25] The baby boomers are getting older. By the end of this decade, all the baby boomers will be 65 and older. By 2040, all the baby boomers are going to be over 75. So the bottom line is that we're going to see a massive explosion, what I call an age quake. Not only older people, but people in late life. Baby boomers have an extremely high divorce rate. They're entering old age, unmarried and alone. And adding to the complications that this baby boomer cohort also had fewer babies, what this means is that they are going to have less likelihood of being able to depend on a child. So we're going to have a much higher share of older persons in their 70s and 80s. We're not going to be able to count on an adult daughter or an adult son to help them when they become older. This generation of baby boomers who are going to be in their 70s and 80s, I think have the potential of being more connected with their outside world than any previous older generation before them.

They have more transportation options. The era of Uber and Lyft, much more flexible ways of reaching places. And once upon a time, if you had food delivered to your house, it was a negative stigma, something negative. You can get your drug prescription. You get almost all your household goods and services without leaving your house. Older people are not just going to be connected to their outside world. The outside world are going to be connected to older person. One of the positive aspects of the COVID pandemic, and it's hard to imagine anything positive about it, is that in motivated older people to become digitally connected. They started using FaceTime more and they started... Because they were pressured. They wanted to keep in contact with their family, with their friends, and this was the only way they could accomplish it. But the bottom line here is that we're going to have this new technology I think that will make it easier and safer for older people to remain in their own homes.

Mariam Sobh [28:32] If we're lucky, we'll all live into old age, but where we'll age really seems to be the question of the day. For some, the thought of leaving their homes is beyond the pale. And for others, the idea of downsizing without worrying about gardens and house upkeep, is nothing more than a delight. After 50 years of home ownership, no matter where one decides to age in place, the reality is that money and access will always dictate where they live out the rest of their lives. I guess the days of retiring a parent to a small house on the grounds of the estate are long over, if they ever existed.

What we have now is a system which empowers seniors while at the same time having their own costs, benefits, and pitfalls. I suppose if it were as easy as keeping the life you always had, this wouldn't be a conversation. As developers and investors lean into the space of senior living, will they listen to their customers on what they think is best? Or will it take the sheer force of baby boomers to upend the sector into something which fits their golden years? Call me in 40 years and we'll see where we are.

I'm Mariam Sobh. This is Changing Places. Changing Places is brought to you by Avison Young. Our producer is Andrew Pemberton- Fowler. Our sound engineer is Patrick Emile. Our producer assistant is Hugh Perkic. Additional production support is provided by JAR Audio.