The original article, Institute Talk: A Conversation with Benchmark Senior Living Founder Tom Grape with Len Fishman, appears on The Gerontology Institute blog, University of Massachusetts Boston.
Assisted living has been an extraordinary successful model for combining housing and personal care. But the cost often puts assisted living out of the reach of many middle- and almost all lower-income elders and their families. Benchmark Senior Living, a leading provider of senior living services in the Northeast, recently opened a new community in North Attleboro, Mass., that found a way to lower costs by rethinking space and the way residents live.
Gerontology Institute Director Len Fishman recently met with Tom Grape, the founder and chief executive of Benchmark Senior Living, to talk about the economics of assisted living, the ideas behind The Branches community in North Attleboro and other issues that affect the cost of senior living services. This is an edited transcript of their conversation.
Len Fishman: There are a lot of variables in calculating the cost of assisted living, from the size and type of accommodations to the services required for residents. But, roughly speaking, what does it cost to reside at a Benchmark community today?
Tom Grape: Compared to other alternatives, assisted living remains far more affordable unless you’re going to qualify for Medicaid. In Massachusetts, market-rate assisted living can range from a studio apartment starting at $2,500 to $3,000 a month, including typically three meals a day, housekeeping, laundry, transportation, activities, and some modest amount of personal care. And then a studio might be $3500 a month at the higher end with that same basic level of services. A one bedroom might range from $3000 to $4000 roughly, and then a two bedroom might go from $4000 to $6000. Those are starting points.
LF: What about additional services residents may need?
TG: Almost every provider in Massachusetts will assess each resident before they move in and will do periodic reassessments. So, for example, if they fall or have a medical change in their condition, the community will reassess their condition. If it determines that they will require more care, then they will assess an additional charge for that higher level of care. You also might be charged additionally for how much intervention is required to manage your medications. Communities do it in different ways but almost all I’m aware of will charge extra for those extra services.
LF: Memory support is a level of care where obviously you’re dealing with a much greater need for personal care services. What would that cost?
TG: Memory care is definitely more expensive than the numbers I’ve quoted because the starting point level of service is definitely higher. So those would typically start at $5,000 a month and could go up to $9,000 a month depending on, again, the level of care, supervision, and assistance required.
LF: From a provider’s point of view, what are the economics behind those rates? What does it take to run a community?
TG: It goes like this: For every dollar of revenue we take in, approximately 70 percent goes to covering operating expenses. That’s staff primarily, utilities, insurance, food, those kinds of things. Approximately 20 cents of that dollar will go to cover the costs of the building, debt service. And 10 cents, if you’re a for-profit provider, might go to profits. If you’re a non-profit provider, that might build reserves.
LF: So how does your new community in North Attleboro alter that equation and try to make assisted living more affordable?
TG: The fundamental challenge is that the building will do part of it, and that’s what we’ve addressed at The Branches. But it doesn’t address the real need, which is some form of [financial] help on the service side. Still, we said let’s do what we can with the building. We reduced the size by about 35 percent from a normal, traditional assisted living building. And we chose to do that by not substantially changing the common areas, but by reducing the size of the apartments. In North Attleboro, we offered all “companion-living” apartments. There isn’t the array of apartment options that we have in our other market-rate assisted living communities that would include a private one-bedroom apartment or a private two-bedroom.
LF: What does companion-living look like?
TG: When you walk into any of the apartments, there’s a very small common area in the middle, which has a kitchenette and a little seating area, perhaps for a shared dining table or something, and then on either side is a studio apartment, each with their own private bathroom.
LF: Were there any other construction elements that helped keep expenses down at this community?
TG: We chose a more moderate-income community to build it in, North Attleboro We were also able to do it on a single story, which allowed us to do it as stick-built construction. We haven’t done a stick-built building in a number of years.
LF: So how did all that affect the rent at Branches?
TG: That, along with some changes to the program, allowed us to reduce rents by 20 to 25 percent compared to traditional assisted living buildings. So it’s not enough to get to low-income folks but it is a meaningful difference. The charges are $3,000 to $3,700 a month, depending on the configuration of units.
LF: The Branches opened last November. What has been the response so far?
TG: We’re well ahead of our projections. We’re obviously interested in the notion of offering all companion units and how that would be received. We have companion units in a number of our buildings, so this is not a new concept, but we’ve actually built activity programming around it. When we’re meeting with folks about The Branches, we talk about the benefits of companion living – as opposed to, “Well, we have no other apartment, we have this companion unit,” which is sometimes how others sell their companion units. Here, it’s actually a feature we’re selling.
LF: So you’re almost reframing it as a kind of buddy system?
TG: Yes, and people have responded to that with great enthusiasm. Again, we built it into our activities programming. The move-in process is all about the buddying-up process. So it’s not an after-thought or a compromise. It’s a central element to what The Branches is and people have loved it. It’s the socialization aspect of the companion units.
LF: You elected not to reduce the common areas in any appreciable way at The Branches. Why was that?
TG: Our view was that because the units are going to be smaller and we’re selling the socialization aspect, we wanted people to have sufficient common area to socialize. We wanted people to get out and have plenty of activity space, courtyards, game rooms. We thought that was consistent with the notion we’re advocating here. It’s not just about the lower price, it is about the socialization aspect of companion living. So common areas were in fact central to that.
LF: Do you expect to build more communities based on The Branches or how might the design evolve?
TG: We do imagine doing more of these. We are still doing research about what’s happening at The Branches to learn from it. But the response has been so great that we are expecting to do a few more. One thought that we’re entertaining is not necessarily having 100 percent companion units, but having a little bit more of a choice. There are some other tweaks we’ll do but I think that’s the big issue. And yet we want to stick with the principle notion of this, which was socialization and companionship. So we’re not going to go against that.
LF: Are there other approaches to affordability you think would be helpful? One obvious question is whether you would like to see Medicaid covering assisted living in Massachusetts the way it does in some other states?
TG: Medicaid does cover assisted living only to a limited degree through the Group Adult Foster Care program. The problem is the reimbursement rate hasn’t changed since 1994.
LF: In some other states, there was a move to adopt what was overtly called the “nursing home substitute model” of assisted living that allowed for a level of care that could go as high as the nursing home level. That’s not possible in Massachusetts because we have adopted one of the more restrictive regulatory regimes that prohibit the provision of health care services in assisted living. Would you like to see a change in that regulatory regime?
TG: The regulatory structure in Massachusetts doesn’t allow assisted living communities to be assisted living communities, forget substitute nursing homes. We have the most restrictive regulatory structure of any state in the country. No other state in the country does not allow nurses to be nurses in assisted living communities.
LF: Let’s go to the example you gave of somebody who no longer can self-administer medication. How does the situation in Massachusetts differ from that in other states you’re in?
TG: Well our RNs – fully trained RNs who may have an evening job in a hospital emergency room – when they’re under the employment of an assisted living community are not allowed to administer shots. So if you’re a diabetic living in an assisted living community, the fully qualified RN is not allowed to administer a shot or put an eye drop in or do basic things like that. Residents have to call a home health agency or have some other arrangements made. That’s just outrageous.
LF: How did that happen?
TG: I think it comes down to in the early days when assisted living legislation was being passed. There was a negotiation with the nursing home industry and a way to have this be passed with their support was to limit some of these skilled services. That was fine in the early days of assisted living, when the acuity of the folks we served was much lighter. As we know, the acuity throughout the health care continuum has increased dramatically in the succeeding twenty-plus years.
LF: What’s the effect on consumers, what’s the effect on people who live in assisted living and their families?
TG: It absolutely makes it more expensive and less convenient and potentially poses health risks. Families move in with the expectation that mom or dad will be able to get all of their care needs met in this assisted living community. They move in only to find, whether the need existed at the time they moved in or whether mom or dad becomes diabetic or whatever a year later, that in fact we can’t meet that need. That you have to now arrange for a home health care agency to come in and provide for these services that seem so basic.
As we begin the summer living our mission to connect people to what's meaningful and possible at every stage of life, I'm challenging everyone at Benchmark to bring our core values to life through our second, annual Radiant Acts of Kindness. Throughout July, our goal is to be creative about transforming the lives of individuals, neighbors and organizations in all our local community through human connection and surprising acts of kindness.
Last year, our first Radiant Acts of Kindness campaign resulted in 1,204 total acts committed by associates in our nearly 60 communities across seven states. That total led to us presenting a check for $1,204 to the Waltham Council on Aging. This year, the community with the highest number of Radiant Acts will get to choose a local organization for us to present a check to -- and I'm hoping it's a BIG check!
Watch our Facebook pages for #BeRadiant2018, and join us on our month-long campaign to bring our Benchmark core values to life: Called to Care, Better Together, Be the Benchmark.
On May 29, Starbucks closed more than 8,000 U.S. stores to conduct anti-bias training with 175,000 employees.
When reading about Starbucks’ planned response to the April racial bias incident in one of its Philadelphia stores, this comment from executive chairman Howard Schultz caught my eye:
“The company’s founding values are based on humanity and inclusion. We will learn from our mistakes and reaffirm our commitment to creating a safe and welcoming environment for every customer.”
At this very moment in time, as we at Benchmark are redoubling our efforts to rename and refresh our own “founding values,” the Starbucks experience serves as a wake-up call for us.
Although we have a diverse team of 6,100 associates, we have much work to do when it comes to being truly inclusive. And being anything less than fully inclusive is not OK.
We are not immune to the same sort of conscious and unconscious bias that the Starbucks anti-bias training was designed to help overcome. And, like Starbucks, we know that one afternoon of diversity training cannot eradicate stereotyping or prejudice. However, with our Benchmark beliefs as a compass, we can make strides together toward changing ourselves so that we, in turn, can transform the lives of others.
I strongly believe that, if we truly strive to “deeply understand people, meet them where they are, and connect them to what’s meaningful and possible at every stage of life,” as our mission states, we will look at one another, our residents, our families and neighbors and look past their race, gender, age, religion, ethnicity, nationality, sexual orientation or any other point of differentiation.
At Benchmark, we see a world in which every person feels meaningfully connected to what matters most throughout their lives. Not only must you and I “see” that for everyone, we must also attract individuals to our company who “see” it, too.
With that in mind, an important step we’re taking is to hire individuals across our company who not only represent diversity but also command our respect by demonstrating that they, like you, are Called to Care and believe in and practice inclusivity.
As I stated after last year’s unfortunate events in Charlottesville, Va., we want everyone to feel valued, safe, welcome and included at Benchmark, and we are opening a dialogue and implementing training programs to help us live our values and break free from cultural bias and racism within our ranks. Last week, senior company leaders met with a seasoned diversity specialist who will contribute his guidance as we assess what to do from an organizational learning perspective.
For us to create the culture we desire and produce life-transforming experiences for our residents, family members and fellow associates, each of us must uncover the conscious and unconscious bias holding us back from treating everyone equally. Only then can we reshape our organization and Be the Benchmark for inclusiveness. And only then will we truly connect to what matters.
As we celebrate Mother’s Day, I want to recognize all the Benchmark moms among us – residents, family members and associates – who have guided, inspired and cared for their families, despite typically “burning the candle at both ends” to manage the torrent of daily needs.
And to our mothers, whether your children are grown or still in diapers, we want to acknowledge how you inspire and transform lives – our lives – through meaningful human connection and hugs!
Each year when this day approaches, I’m reminded of my own mother and the inspiration she was to our family and, especially, to me.
While raising four children ranging in ages spanning 16 years, my mother was an active volunteer, including chairing the Fairfield, Conn., Board of Recreation, heading the PTA and founding and leading an important local Save Our Sports campaign when the school district threatened deep budget cuts. (The campaign succeeded!)
Starting my sophomore year in high school, mom served as a career counselor, advising my fellow students on their college and career choices. My memories of seeing her walk the halls of Roger Ludlowe High School are rekindled each time I visit Sturges Ridge of Fairfield, our new community set to open in September. It is right next door to my high school!
Mom was a real force in town, and my friends lovingly called her “the tiger.” She had charisma, presence and a dynamic personality. Of this I’m certain - in a different generation, Lee Grape could have been a CEO! How very grateful I am for the love and influence she showered on me.
To all our Benchmark moms on Mother’s Day and every day – thank you for transforming lives through human connection in your most important role: Mom.
I’m moved by the stories I regularly hear about how deeply our nurses care for residents, families and their fellow associates. As we celebrate National Nurses Week, May 6-12, I want to acknowledge and thank all our Benchmark nurses on the front line serving in such critical roles.
It’s fitting that this special week ends on the birthday of Florence Nightingale, a trailblazer and founder of modern nursing.
Through empathy, professionalism and tireless commitment to helping others, Benchmark nurses embody our Benchmark value of being Called to Care.
Our 732 nurses across Benchmark provide care on many levels, demonstrating that we are Better Together – whether it’s saving a life, holding a hand and even honoring residents by covering them with a handmade quilt as they exit a community for a final time.
When a resident she cared for and who meant a great deal to her passed away, Francine Morton, Memory Care Nurse at Shrewsbury Crossings, was saddened to see her leave the community unceremoniously. So, she decided to honor residents in the future in a special way.
“Our residents receive a lot of fanfare when they arrive, and I wanted to create a similar experience for those exiting our community,” Francine says.
She contacted a close friend to design a quilt using associate clothing and a Benchmark blanket as backing. Excited at a chance to contribute to such a wonderful project, her fellow associates donated shirts in a variety of colors, including a Service Champion shirt.
The finished product is a special expression of this Benchmark community’s love for its residents, and it’s one more lasting reminder of the difference that one nurse can make in a community. How fortunate we are to have 731 more nurses just like Francine who are connecting to what matters.
Thank you, Francine, and every one of our Benchmark nurses for all you do on every shift to transform the lives of those in your care through human connection.
Lately, I’ve been reminiscing a little about my childhood holidays. I can finally admit to sneaking around the house as a kid, looking for what “Santa” would bring, and then – having already previewed my gifts – perfecting the look of surprise when Christmas morning finally came!
When we were kids, the holidays were all about receiving gifts, and, well, maybe they still are. But as we get older, this season is also about giving.
For Grace Passarelli, it’s about both.
Grace, 90, is one of our delightful residents at Ridgefield Crossings in Connecticut. Every night, she crochets hats to give to the Connecticut Children’s Medical Center emergency room. She started doing this after her sister, Margaret, passed away last June. Margaret, who lived in the community’s Harbor, had been the recipient of Grace’s attentive care for years. Now, making little tams, berets and stocking caps gives Grace a new purpose.
When it turned cold earlier this month, Ridgefield’s Harbor Program Coordinator Debbie Grace took all the hats Grace had made since June to the medical center and placed them in the care of an ER nurse named Shaina. There were nearly 100 hats!
On Dec. 7, a 6-month-old baby was brought into the ER with hypothermia. The doctors prescribed keeping the baby warm. With hats.
Shaina sent mother and baby home with lots of hats, and, Debbie says, the mother was “incredibly grateful and wanted to thank the wonderful person who helped her baby without even knowing them.”
Having a new purpose this Christmas – Grace’s first without her sister – is a gift she receives for giving hats to those needing them most.
Receiving. Giving. Remembering those we miss and all those we love. This is the season for it all.
Below her Benchmark email signature, Ridgefield’s Debbie Grace has this Pablo Picasso quote: “The meaning of life is to find your gift. The purpose of life is to give it away.”
My hope for you this season is that all the gifts of compassion and meaningful moments you give to others every day will return to you in ways you never imagined. When it happens, look surprised . . . and receive it with joy!
May your holiday be memorable and blessed.
For over a year now, we’ve talked a lot about our mission to Elevate Human Connection, and we've focused a great deal of energy discussing Benchmark’s core values. Among those values is respect for one another.
In light of recent events involving personal conduct and disrespectful actions in the business, political, media and entertainment worlds, it’s important for us to reinforce our value for treating one another with respect. It’s the right thing to do.
Additionally, our unified commitment to our mission and core values is our strongest “firewall” against the threat of discrimination and harassment plaguing so many other organizations.
Nevertheless, it remains important to remind ourselves that Benchmark does not tolerate any form of harassment based on race, religion, color, sex, national origin, age, disability, marital status, pregnancy, sexual orientation or any other category.
We also believe that every associate shares the responsibility for ensuring our workplace is free from discrimination and harassment. That means, if any of us sees or experiences any behavior, language, action or appearance that is inappropriate for our workplace, it’s our obligation to inform a supervisor or manager so that it can be addressed quickly and candidly as outlined in the Associate Workplace Guidelines and Code of Conduct.
Recently, we sent a questionnaire to all associates, asking for your thoughts on what “human connection” means to you. Among the early responses, one stands out to me: “People feel connected when they are seen, heard and valued by others.”
That response truly is the “how” behind our mission to Elevate Human Connection, and it’s the secret to creating and maintaining a positive environment in every Benchmark community.
I chose Benchmark as our company name 20 years ago to signal that we expected to set the standard of excellence by which all others are measured. The respect and dignity with which we treat one another at work is one of those important measurements, and it’s how we will Elevate Human Connection and be a values-based company for the next 20 years and beyond.
To each of our 6,000+ associates across the Northeast: Thank you for the work you do to bring Benchmark to life for our residents, families and one another every day!
Holocaust survivors. World War II veterans. Even a peace broker between India and Pakistan.
Those are just some of the more than 6,000 residents living with us in Benchmark Senior Living communities across seven states in the Northeast.
More important than where those brave individuals live is how their experiences can inform our response today to the same racism, bias, hatred and violence they lived through and fought against in the past.
As a values-driven company, Benchmark wholeheartedly condemns all expression of bigotry that has reared its ugly head throughout history and once again attempts to sink its poisonous claws into a world desperately in need of empathy, kindness and connection.
Serving families and their senior loved ones with empathy and without bias has been our goal for over 20 years, and the thought of anyone in our care or in our community being treated disrespectfully goes against all we believe in.
Since the events in Charlottesville, we at Benchmark have taken time to reflect on and recommit ourselves to our mission to Elevate Human Connection in all that we say and do.
With that in mind, Benchmark has chosen to contribute to a project under way in Boston that will stand for inclusion and peace: Martin’s Park.
Eight-year-old Martin Richard lost his life in the 2013 Boston Marathon bombing, and many of us remember seeing the picture of him holding his handmade poster, “No more hurting people. Peace.” With our contribution, Benchmark embraces the values of the Martin Richard Foundation – “Choose kindness. Build bridges. Do more.”
Additionally, we are planning to launch internal initiatives to reinforce our values and support our goal of being free from any cultural bias and racism within our ranks so that everyone feels valued, welcome and included, regardless of nationality, race, religion or sexual orientation.
It’s important to us that our current and future residents, families, associates, business partners and agencies understand how deeply we are committed to our values and mission. We want all individuals to feel, when walking through the door of any one of our Benchmark communities, that they are entering a place of civility, empathy and human kindness. That’s how every home should be, and that’s why so many call Benchmark home.
I’m often asked why I started Benchmark, and now that we’re in the eighth month of our 20th year, it’s a good time to share that story with associates who may not know it. I think it’s also helpful to share what we did differently at the beginning to set us up for 20 years of success . . . as well as what we did that almost “killed us” before reaching our 10th anniversary!
What today’s high-tech companies went through in their early years, we went through, too. Like having a set of index cards as our accounting system. And being so undercapitalized that we frequently didn’t know how we’d meet payroll. I remember those days vividly. Especially the first day.
On Jan. 1, 1997, I moved into a rented space with two little offices in a building on Walnut Street in Wellesley, Mass. There was an area on the right where I could fit a desk, and I moved in by myself along with my new Dell computer, which I had ordered online. That was a big deal at the time, and I thought it was pretty cool.
I’d been in the senior living industry for a few years before that, having started in 1991 at a company called ADS, a local nursing-home company where I helped start a new affiliate called ADS Senior Housing. For them, I built 13 or 14 assisted living communities, which were the first ones in Massachusetts and Connecticut. The principal owner of that company decided to sell it in 1996, and I didn’t want to go with the company he sold it to. That’s when I started Benchmark Assisted Living.
After moving into my little office in 1997, I proceeded to put together a business plan and went off to raise some capital. After a couple of months, I got a commitment for $25 million in capital from a Boston investment company called AEW, which still actively invests in senior living. I remember thinking, “Oh my God, how am I going to invest $25 million?” Of course, since then we’ve invested $1.3 billion!
At that time in the industry, the late ’90s, assisted living was brand new, and it was really red hot. Companies were going public when they had just three or five communities, which I thought was ridiculous.
Experience Helps Forge a Different Business Plan
There virtually were no communities to buy, so everybody was in a development or new-construction mode. And that was the business plan for Benchmark – to build new communities. With our first $25 million commitment, we built eight communities and acquired three. Pretty good for a brand-new company!
Now, one thing I had learned the hard way was how investors work: They invest pension-fund money or school endowment money, they build something or turn it, and then they have to sell because, ultimately, they have to determine their return in order to know what their profit is. They can’t own for a long time.
I didn’t want to repeat my experience at ADS where, halfway into building an enterprise, the company was sold and I was out of business. This time, I wanted to control things, so my deal with the investor was to create a real estate company and a management company. Real estate requires a whole lot more capital, so I said to AEW, “Why don’t we invest together in the real estate, and I’ll own the management company?” And that’s what we did. We invested jointly in the real estate, and I went off and raised a bit of money for the management company on my own.
That was a really important decision because, had I done it together as they originally suggested, when they wanted to sell, I would have been out of business – again! Having control of the management company allowed me to do the successive joint ventures with different investors, and that’s the way we’ve operated ever since. Does it have downsides? Of course. But it has, strategically, been a very important decision for Benchmark.
Some Mistakes You Just Never Forget
There were a couple of moments in the early years that almost killed our company. Keep in mind that we started off in 1997 to develop. We began construction in 1998, 1999 and 2000, and by 2001 we were managing six communities and developing eight. Well, it takes a while to find sites, get them permitted and start construction, and we planned to open five of those eight in the first half of 2001. Plus, we acquired the Crossings portfolio of eight buildings on March 30 of that year. In all, we took on 13 more properties, and we almost killed ourselves! But we survived.
Four years later, in 2005, while we were managing 14 or 15 communities, we acquired 19 more! Within a 12-month period, we more than doubled the size of the company, and, of course, it was the second time, by doing the same thing, that we almost killed ourselves again. I used to have a great quote about how we learned to do business in those early years: “We’ve had to make every mistake twice just to make sure we didn’t forget.”
Hey, it’s 2017 and Benchmark has more than survived for these eventful 20 years. And while I assure you that we’re still learning from our mistakes, I can also say, with pride and gratitude, that we’re building a future on all that we’re doing right.
When some people observe 20th anniversaries like we are this year at Benchmark, they think about looking back and celebrating. But I like using a milestone year to refresh and launch the next chapter for our company.
To make this year even more meaningful, we’re addressing a nagging problem that I have not dealt with successfully in our first 20 years. But I think I’ve got it this time! I’m referring to how we describe our company purpose in a mission statement.
We’ve had two mission statements over time. For the first 10 years, it was, “To creatively improve the experience of aging.” A lot of people liked that. Sounds sort of cute but doesn’t really say much.
For the last 10 or so years, we’ve had – I hope this is familiar to some of you – “To build a great company, providing world-class senior living experiences.” Sounds nice, but what do we mean by world-class senior living experiences? We’ve never been particularly clear about it.
I love books by Jim Collins and other business authors who write about great companies and their mission statements, which have a few common characteristics. First, they’re usually very short. For example, Disney’s used to be, “Make people happy.” Everybody remembered it. But whether you’re a frontline housekeeper, food server or home office accountant – do you remember, “To build a great company, providing world-class senior living experiences”? Probably not.
So, first, a mission statement needs to be short and pithy. Second, it needs to be a transcendent idea. It’s like a cause, a mission. It’s not about what we’re doing today, but rather it’s a higher calling that people can get excited about. For example, drug company Merck is known for its mission “to preserve and improve human life” an aspiration far bigger than just making the best drugs.
Finally, a mission statement needs to communicate to everyone in the company what they’re supposed to do.
At Disney, if a kid drops an ice cream cone, everyone knows what to do: Help the kid feel better, perhaps by getting another ice cream cone. No one needs to stop and debate what to do.
But what does it mean to “provide world-class senior living experiences”? What are you and I supposed to do, and what’s the transcendent idea? It’s not just what we’re doing today. It’s a higher calling. It’s something we can get excited about together.
So those are three characteristics of great mission statements. Unfortunately, in 20 years, I’ve been 0-for-2, and I’ve lost sleep over that! It’s now our 20th anniversary, so I’ve got to get it right. And I believe we have!