• March 7, 2017

    Meet Bob Kramer, founder and CEO of the National Investment Center for Seniors Housing and Care, or NIC, based in Annapolis, Maryland. As the data hub for the seniors housing industry through its NIC MAP service and provider of one of the industry’s largest annual conferences each year, NIC was founded as a non-profit to enable access and choice for America’s elders in seniors housing and care by informing debt and equity investors on seniors housing, and helping the industry gain a position as a core real estate property type.

    Spotlight on Technology

    Many people think seniors housing is behind in technology adoption. Would you agree?

    Yes, I think our sector has always been late adopters of technology. On the skilled side, that’s because of a low margin business with the wrong payment incentives; you’re not exactly incentivized in Medicaid and Medicare to innovate. On the private pay side, I think again there hasn’t been a driving need for it. That said, that’s changing now. It’s changing for a host of reasons. Ultimately, there are several primary drivers.

    What are those drivers?

    One is the consumer driver. There’s a policy driver, and there is a technology driver. The consumer driver is the longevity revolution, and the fact that we’re going to be serving a new and demanding customer. That new and demanding consumer doesn’t want to be called a “senior.” I’m often asked, given my passion for this field, “What’s the future of seniors housing going to look like?” I say that I don’t really know for sure, but I’ll tell you a couple things I do know.

    First of all, boomers for the most part won’t retire—they’ll transition. My wife and I haven’t been to a retirement party in five years; we’ve been to transition parties. What’s a transition party? It’s when you announce what you’re doing next, rather than declaring you’re done.

    The policy driver is the huge changes taking place in health care payment and delivery reform. One of the important points here is, rather than seniors housing in a sense moving [toward a] medical [model], medicine and health care is moving to seniors housing. In the effort to bend the cost curve, increasingly those in health care are coming to understand that if you want to produce better outcomes and you want to lower average per person costs, [there are] several things [to consider]: one, where you live matters; it matters a lot. Two, social supports and socialization matter; they matter a whole lot. Three, the coordination of all these things is critical.

    Then the technology driver. I think there are three key things here: the rise of the on-demand economy, robotics, especially social robotics, and the internet of things, where inanimate objects are now becoming sensors that not only report but also analyze data. [For example,] the diaper in Japan that tells you not only when someone needs to be changed, but [also provides] an analysis which says if they’re at risk of a UTI. Well, that creates huge staff efficiencies and better care. I think the internet of things and the cloud in particular and how they are changing telemedicine and telehealth, and enabling better health care management for frail elders will be a positive, disruptive force in the seniors housing and care industry.

    Do you think if you’re an operator and you’re not trying to innovate with technology, that you’re going to be left behind?

    It’s bigger than technology. If you’re doing this for the sake of being hip with technology, you’re probably not doing it for the right reasons and you’re likely to fail. You’ve got to first ask the basic questions, ‘How’s our customer changing? What is our customer really hiring our staff to do?’ In other words, you’ve got to be like Steve Jobs and Wayne Gretzky, you have to be skating to where the puck is going, not to where it is now, and that’s how you need to be applying technology.

    See “Insights into Technology” below for more on the topic of technology.

    Tell me about how NIC got started—you’re the original!

    I was first exposed to the industry as a state legislator. There was a troubled not-for-profit CCRC, and the Speaker of the Maryland House called and asked me to serve on a task force to rewrite the CCRC regulations in Maryland. I turned to my aide and said: “What the heck is a CCRC?” That was my introduction, in 1983.

    Then a couple months later, an admiral named Charlie Minter walked into my office—and when you’re a freshman legislator representing Annapolis in the general assembly of Maryland, and an admiral walks in, you do what I did—I stood up and said “Yes sir,” he said “Son” and I said “Yes sir”—“We want to build ourselves a retirement community, and we need your help.” That turned out to be what today is Ginger Cove, a single-site CCRC.

    When Bill Marriott decided to take Marriott into senior living, he knew me through another not-for-profit that I’d been involved in. His team approached me and asked if I’d be the founding executive director of the first trade association in the seniors housing field, which was called NASLI in 1985 (the National Association for Senior Living Industries).

    I realized after a couple of years I really didn’t want to run a trade association. I left and did some other things, and then in 1991 got together with three other guys I’d gotten to know in the industry, Al Holbrook, Tony Mullen and Bob Eramian.

    We knew clearly the industry would grow, and to grow, it would need capital. We had the idea of putting on a conference to bring together debt and equity capital providers with operators on a national level, and I offered to put on the first such conference. I went up to New York and spent a week interviewing different types of debt and equity investors, asking what would it take to get them to come to a conference, and what would it take to get them to invest in the space. The answer to the question of what it would take to get them to invest was good data from a trusted source.

    NIC started in ’91; we had our first event, we formally incorporated in ’93 and from the beginning the strategy was, host events not only to bring about connections and to provide education, but also to provide the revenue to invest in research and data. Use that research and data to then create more transparency in the space and to create a performance database, and use that database to attract more capital, especially institutional capital, and to attract cheaper capital. Not highly opportunistic capital that was investing in something that was viewed as a fringe alternative asset, but rather, eventually, the goal has always been to get seniors housing considered as a core real estate property type.

    That was the original vision in ’91. It got put into a specific strategy and game plan in ’94, and we’ve made enormous progress, but the industry still lacks the level of transparency provided by other commercial real estate property types and increasingly demanded by consumers.

    For instance, the industry lacks good aggregate time series data on financial performance at the property level, including NOI. In addition, the industry lacks any type of standardized accounting. Ultimately, the industry needs a uniform chart of accounts. Finally, as dramatic changes in post-acute care and long-term care payment and delivery cause the lines between seniors housing and skilled nursing to become increasingly blurred and the capital requirements for the skilled nursing sector to intensify, investors, payers and risk takers all need more timely data that tracks the changes taking place in this sector. We are working in each of these areas to address these needs.

    Do you think the downturn, when seniors housing continued to perform better than other property types, was a turning point for the industry?

    It was key in terms of catching the attention of institutional investors, especially due to the comparative performance data that was available.

    I think the issue of how we’re going to provide housing and care for seniors, especially frail seniors, in the 2020s will be a major domestic policy issue, political issue and budgetary issue. I also think many people realize that finally, after years of saying “the boomers are coming, it’s all about the boomers,” finally ten years from now we will actually start serving the boomers. Up until now, it’s really been the boomers as adult children that have driven change in the sector.

    When you started NIC, did you ever see it growing to this point?

    I can’t honestly say that I foresaw the size of organization and budget that NIC has grown to, but I did foresee our impact. I never start something where I don’t think big, and I’m a bit of a contrarian. If people tell me something can’t be done, that really gets me motivated, and I fully believed that this strategy was the right strategy to help the industry grow and to meet the ever increasing needs for housing with supportive services for America’s elderly.

    In terms of meeting those needs, some are trying to provide everything you could ever want up until the point you can’t live there. Do you think that’s a good strategy?

    I think about it a little differently. In the future you’re going to be trying to address the needs of the people that are living within your four walls, and also looking to see if the capabilities you have to serve them are things that can take you out of your four walls. Put another way, we think there are huge value-capture opportunities for both providers and investors and ultimately for the residents, of seeing partnerships—not so much buy or build, but partnerships between traditional real estate-based providers of housing and care and non-real estate based providers of health, wellness and supportive services.

    We call the folks in the non-real estate bucket the enablers and the extenders, because they bring additional capabilities that most seniors housing and care operators don’t have, that you need, particularly if you’re going to manage the health care situation and the quality of life desires of your residents. And when you have those capabilities, it also offers an opportunity to go beyond your four walls into the community. Not everyone will choose to do that. We believe there’s value that can be unlocked for the provider of the housing and care, the provider of the non-real estate-based service, and their investors, and ultimately for the frail senior customers and their families, by crossing the silos. Historically, investors and providers of real estate-based care have tended to view these other folks, such as home care and enhanced primary care delivery at home, as competition. On the other hand, many non-real estate-based providers and their investors have dismissed seniors housing as institutional and failed to recognize that many frail seniors call this setting home and value the socialization as an antidote to loneliness. Ultimately, non-real estate-based providers of health and supportive services are targeting frail, at-risk seniors because they are the most costly health care consumers. These frail, at-risk seniors are overwhelmingly the profile of the residents of today’s senior living communities.

    Are you then still responsible for managing that more complex resident if you’re doing home care as a seniors housing provider?

    The reality is, when you’re the surrogate for the adult daughter, the value you provide is enhanced the more you serve as the advocate/manager for her mother or father. She expects you to be that manager. People are going to be looking for full service solutions. We’re moving away from [silos] and it creates an incredible sweet spot for the seniors housing provider and, quite frankly, for the skilled nursing providers as well.

    People are going to be looking for full service solutions. We’re moving away from [silos] and it creates an incredible sweet spot for the seniors housing provider and, quite frankly, for the skilled nursing providers as well.

    What advice would you give a senior living provider who’s looking to take advantage of what you’ve been talking about with all of the different services?

    Understand, first of all, your local market. Who is taking risk in that market and who is ultimately the payer when it comes to health care for frail seniors? Eventually, and by eventually I mean ten years [from now], I think we’ll move to more of a population health model.

    Prepare to ride the wave, but to do that, timing is critical. If you paddle too soon, you wipe out spectacularly. You may say “Oh, I’m way ahead of everyone else,” and then boom! Spectacular wipeout! But, what happens if you paddle too late? You miss the wave, you’re marooned and in our industry, you may be out of business.

    Leadership Insights

    What’s your definition of leadership?

    First, leadership and being a leader is not a title or titles—it’s qualities. Second, it’s the ability to coalesce people around a positive, shared vision of the future and to motivate them, because if you’re the only one who has the vision, you’re very limited in what you can accomplish. A leader is someone who really inspires others. Ultimately, I think leadership is connecting people to something that gives them a positive sense of meaning and purpose that is personally rewarding in what they’re doing. You can be a leader regardless of title. You may have the title of CEO and not be a leader.

    What was the biggest challenge you’ve faced?

    The biggest challenge I’ve faced was coming in, starting NIC and trying to sell leaders in the industry on both the capital and operating side on the value and importance of sharing their companies’ data and transparency. [It was a challenge] for a couple of reasons. One, as I alluded to earlier, many of the great leaders, in terms of having built incredible operating companies, were strong entrepreneurs who had pioneered successful companies in a start-up industry with no data and no transparency and were not sure they now wanted to share their data. Second, many investors were capitalizing on the inefficiencies of the market that was not at all transparent. NIC was seeking to make the flow and pricing of capital more efficient and transparent. Investors had to be convinced of the long-term value for the industry and therefore for their investments.

    What’s the biggest risk you’ve taken in your career?

    More from the Leadership Series

    Launching out in 1989 to start my own proprietary company—a boutique communications firm specializing in facilitating public involvement on high profile capital projects. I had spent my career to that point in the government and not-for-profit sectors, but I wanted the experience and challenge of starting my own company.

    Do you ever miss politics?

    Yes and no. First, you know in one sense, one’s always involved in politics, it’s the politics of what? I’m involved in the politics of the seniors housing and care and more broadly the aging services field. The ugliness of the present national and state level political discussion, to me, is saddening. I certainly don’t miss being in the crossfire of that. At the same time, I love the business of making government serve people, but I really do feel what I’m excited about, and the reason I don’t ultimately miss it, is that I’m in a field—housing and care for seniors—that, as I said, is going to increasingly become a major social issue in this country. Secondly, it’s going to become a major budgetary issue, and I’ve had the opportunity to be one of many [who are] part of shaping the growth of a whole sector, providing a badly needed service for an important population—America’s elders, and that’s incredibly rewarding.

    Bob Kramer, NIC

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    What’s the best advice you’ve gotten in your career?

    In business, as in life, it’s all about relationships. That means two things: seek to know and understand the people with whom you are communicating; and two, know yourself. Ultimately, relationships are the source of the most lasting joys and the greatest frustrations and disappointments. To me, that ties back to your question about leadership and being a leader, because it means understanding how people are wired and understanding how you can excite them and motivate them. We are all, at times, narrow-minded and selfish—all of us. It’s not [a situation where] some are, some aren’t. So as a leader, how do you encourage people to rise above that?

    In business, as in life, it’s all about relationships. That means two things: seek to know and understand the people with whom you are communicating; and two, know yourself.

    Focus on relationships, focus on people, and focus on understanding other people…Understand what makes those people tick. Listen to understand them. How do you make them feel proud about themselves, and how can you encourage them because that’s going to be the key to being effective in whatever you do.

    I once had a guy say to me, “Bob, remember, for your ultimate success and especially satisfaction in life, it’s not a matter of who you know and your connections, it’s not a matter of honing your skills and talents. Whatever your flaws, know them and how to address them, because they will bring you down.” I’ve always remembered that, whether it’s putting together a plan and saying, ‘What are the flaws? What are the risks?’ For myself, it’s not my speaking abilities, my abilities to communicate or my abilities as a strategist, but where am I weakest and most flawed, because that’s what will trip me up. That was terrific advice, and I also think it’s good because it keeps you humble.

    Who would you consider to be your mentors, and how have they helped your career?

    I’ve been fortunate to have a number of mentors in different areas of my life, as friends and colleagues over the years. I would say in thinking about seniors housing and care, Arnie Whitman and I for years have enjoyed [each other’s company], we’ll get together several times a year and talk about where the industry is now, where it’s going, what are things that maybe others aren’t seeing that we think might happen. Arnie and other NIC board chairs, such as Ray Braun and Thilo Best, have definitely helped shape my own thinking.

    What about personally?

    Ralph Crosby; he is a former White House reporter who then started a marketing communications firm. I got to know him when I was in the legislature, and when I came out of the legislature and decided to start my own company, I came to him for advice, and he’s been a mentor for me in the world of business. I was a social do-gooder who had always been in government or not-for-profits, and I was starting a proprietary company. What did I know? He was enormously helpful, but he also introduced me to what I call the art and science of marketing communications, integrated messaging and brand management—that was critical for my own thinking. We’ve continued to get together every several months to compare notes and discuss issues we are presently thinking about or dealing with.

    The other mentor who had the most profound impact on my life is my father. He taught me from a very young age the importance of being a critical thinker, one who always seeks to be exposed to and understand diverse and opposing points of view. From him I learned that critical thinking done well enables one to be a creative thinker.

    What would you say your greatest strengths are as a leader?

    I think I’m good at coalescing people around a positive vision. I’m passionate about vision, about mission, but I think one of my skillsets is getting people to get united behind doing something. I love doing it, but I’m a nerd, a student of people and communications, because I believe, as I indicated earlier, that focusing on people and relationships is key to success in business and in life.

    What are your greatest weaknesses?

    In my energy and enthusiasm, I can trample on people without meaning to. I’m outspoken, I’m not lacking opinions, I’m passionate and you’ve got to remember sometimes you can take the air out of the room, and the very thing I said about encouraging people to own the vision is not accomplished. I think that’s definitely one, and the other is that I am very strategic, but there can be a thin line between strategic and manipulative. The strategic person is trying to bring people and coalesce people to develop and pursue a strategy, and when does that become manipulative? Transparency as a leader, that’s important, and how much you meaningfully engage people in being part of that strategy, and part of that solution. Character strengths can become weaknesses, and you’ve got to be aware of that.

    Industry Challenges and Opportunities

    What do you think is the biggest challenge the industry faces?

    I’m not going to answer with one, I’m going to answer with two. The first is the sector’s need for talent and the second is the challenge of affordability of our products for the consumer, which I’ll address later.

    One is people. Recruiting. Training. Empowering. We need people at all levels, which encompasses workforce issues from the very top, the leaders who are going to [create] these new products and new ideas, right down to the frontline caregivers. We’re not an industry that’s top of mind for people to consider as a career. Most young people have never thought about a career in our industry and many have a negative view based on the old institutional nursing home model. I think there’s huge work to be done on that. We’re doing some; our Future Leaders Council, our student scholarships, our university internship program, our focus at the graduate level in major business and hospitality schools. I think people, the need to attract talent and put our sector on the radar screen in a positive way for individuals seeking career opportunities is crucial for the future of our sector.

    This industry offers so much opportunity. I teach each year in the fall at Cornell in their course on senior living offered by The School of Hotel Administration jointly with the Sloan Program in Health Care Management. I always enjoy my time with the students, and I’ll say near the end, “I just want to say, if you want a highly predictable career in a stable sector where the products are pretty much defined, and where your career path is pretty clear and you know that in 10 years to 15 years you can be the manager of a Fairfield Inn in Connecticut, I highly recommend the hospitality sector. If, on the other hand, you want to enter a career field where the product today will be almost uniformly rejected by the customer of tomorrow, where the customer base will grow three- to five-fold larger than it is today, and, if you’re entrepreneurial, you will have the opportunity to rise very quickly and to be in a leadership position, and where you’ll have the opportunity to address a major social issue that’ll be front and center in this country, and truly have a sense of doing well while doing good, then strongly consider seniors housing and care. We’re going to need talented entrepreneurs who want to make a difference.

    This industry is primed for entrepreneurs.

    There’s going to be huge growth in demand, but today’s product and the manner in which it is marketed and delivered isn’t the product that the customer of the future is going to want. At the same time, these other disruptive forces we talked about earlier are going on. So, yes, it’s primed for disruption.

    There’s going to be huge growth in demand, but today’s product and the manner in which it is marketed and delivered isn’t the product that the customer of the future is going to want.

    Do you think the industry has enough entrepreneurs, or do you think we need more?

    We’re going to get more, whether we want them or not. That’s why we do “NIC Talks.” A lot of my time now is looking at, who are the disruptors? Many of them are going to come from outside, they’re going to come from other industries, other product types. Yes, I think a large percentage of the multifamily developers entering our space will crash and burn and be somebody else’s growth strategy at 70 to 80 cents on the dollar. But 20% of them, just to pick a number, will probably be disruptive innovators who will come up with something innovative that appeals to our customers because these developers aren’t saying, “This is the way independent living needs to be done”—they’re going to think in a new and creative way.

    Do you see any new models now that excite you?

    It’s too soon to say. By definition, innovative models are experiments. Some will succeed, many will fail, but even those failures will offer lessons to be learned for future successful innovation. There are a lot of people experimenting with new models.

    How can we do a better job in attracting talent to our industry?

    We need to recruit as an industry, not just as individual companies. To recruit as an industry we need a message and we need to offer career paths. The message we are getting better at, the career paths we’re doing poorly so far. This really is a role for the industry trade groups and I’m encouraged by the work that Argentum is doing through their Workforce Development Initiative. I’m also encouraged by ongoing efforts such as the work Doug Olson, the director of the Center for Health Administration and Aging Services Excellence at the University of Wisconsin – Eau Claire, is doing on his sabbatical on this topic. NIC’s focus has been at the graduate level, especially in MBA programs that have a major focus on the real estate, health care and hospitality fields.

    We need to show career paths to high school students, literally on a piece of paper, ‘Here are ten different entry points and five different direction points you can go.’ We need a packet of information that’s provided to every guidance counselor of every high school in the United States. Just as the physical therapists did years ago. We need, secondly, that same career packet for every career services department in every community college in the United States.

    The majority of the people in this industry are the front line, the caregivers. How do you make a $12/hour job taking care of old people, attractive?

    I think there are several things there. Create a culture of purpose. If you’re trying to get people excited about changing bedpans, good luck. But are you connecting that, instead, to caring for another individual, and particularly taking care of a precious resource—in this case, an elder? We’re one of the most ageist societies in the world, and that’s part of the challenge that we have. For instance, I believe that millennials as a generational cohort present a great opportunity to recruit into our field. Why? Because so many millennials want to have a sense that what they’re doing is tied to something bigger than them, that they are doing something that is not just providing a paycheck but is making a difference. Look at Teach for America and the anti-human trafficking movement; they have enormous appeal. Why do those areas have enormous appeal? Because I’m able to say, “What I’m doing counts for something; I’m making a difference.” First of all, you have to create a culture that makes people feel that way, but in our field, it should be easy to do that.

    But no one is doing it!

    No, I wouldn’t say no one is, I disagree with that. When I look at a Jack Callison [CEO of Enlivant] or a Loren Shook [CEO of Silverado] or a Ken Jaeger [CEO of Morningstar], there are a lot of folks who are doing that, so I would disagree. Not enough are doing it. When I look at the ideas coming out of our Future Leaders Council, I am excited about the next generation of leaders in our field. I think that the various programs starting up at different universities are really encouraging. I’m speaking at a different university almost every month and the opportunities are growing.

    Do students come up to you afterward and say, ‘This is pretty exciting’?

    Yes, but interestingly enough, some of the greatest enthusiasm comes from the foreign students. [There are] different cultural attitudes towards aging and the elderly. There are other societies, both Asian and Hispanic, that revere their elders far more than we do, and it makes a difference. Our country’s been blessed by Filipino nurses. They’re great caregivers; there are cultures that produce caregivers, that don’t demean caregiving, but see it as an honor and a core value to serve someone and that’s a wonderful thing. We have to build on that.

    The second area, in terms of greatest challenge facing our industry, is to address the issue of affordability of our products, specifically for middle income Americans. And it’s not totally without vested interest to say we need to deal with this. Many boomers haven’t saved enough. They don’t realize that if you turn 65 today, and you’re female, your average life expectancy is 89 and if you’re male, it’s a few months short of 87. Well, that means that you have a quarter of your life ahead of you. Many boomers will live into their 90s, and a significant number past 100. So for them at the traditional retirement age, they may have a third of their life ahead of them. We need to address the challenge of a large population of seniors who will not have saved enough for their care needs as they age.

    Many boomers will live into their 90s, and a significant number past 100. So for them at the traditional retirement age, they may have a third of their life ahead of them. We need to address the challenge of a large population of seniors who will not have saved enough for their care needs as they age.

    What’s NIC doing to help with the solution?

    Our focus is on those whose assets are too great to qualify for Medicaid but not enough to afford most private pay seniors housing and care for any significant period of time. We want to understand the size of this market, their economic and demographic profile as well as their health and functional status. We are going to be providing a major grant to a university-affiliated research organization this spring to underwrite a demand study that will look at the size of this middle income market projected out over the next 20 years. The first step to developing both private pay products and government policies to address the needs of this middle income cohort is to understand the size of the market and their demographic, economic and health and functional status profile. The primary audience for this study will be the investment community and private pay providers because we believe there is a significant opportunity in meeting the needs of this growing population. The secondary audience will be the public policy community.

    When do you think the study will be released?

    Mid-2018. We plan to have two products come out of the study. One will be a report for investors and providers. The second will be a paper suitable for publication in a peer-reviewed academic research journal. We expect to convene a national summit on this issue at which we will release the findings of the study and invite responses.

    Insights into Technology

    Many people think seniors housing is behind in technology adoption. Would you agree?

    Yes, I think our sector has always been late adopters of technology. On the skilled side, that’s because of a low margin business with the wrong payment incentives; you’re not exactly incentivized in Medicaid and Medicare to innovate. On the private pay side, I think again there hasn’t been a driving need for it. That said, that’s changing now. It’s changing for a host of reasons. Ultimately, there are several primary drivers.

    What are those drivers?

    One is the consumer driver. There’s a policy driver, and there is a technology driver. The consumer driver is the longevity revolution, and the fact that we’re going to be serving a new and demanding customer. That new and demanding consumer doesn’t want to be called a “senior.” I’m often asked, given my passion for this field, “What’s the future of seniors housing going to look like?” I say that I don’t really know for sure, but I’ll tell you a couple things I do know.

    First of all, boomers for the most part won’t retire—they’ll transition. My wife and I haven’t been to a retirement party in five years; we’ve been to transition parties. What’s a transition party? It’s when you announce what you’re doing next, rather than declaring you’re done.

    The policy driver is the huge changes taking place in health care payment and delivery reform. One of the important points here is, rather than seniors housing in a sense moving [toward a] medical [model], medicine and health care is moving to seniors housing. In the effort to bend the cost curve, increasingly those in health care are coming to understand that if you want to produce better outcomes and you want to lower average per person costs, [there are] several things [to consider]: one, where you live matters; it matters a lot. Two, social supports and socialization matter; they matter a whole lot. Three, the coordination of all these things is critical.

    Then the technology driver. I think there are three key things here: the rise of the on-demand economy, robotics, especially social robotics, and the internet of things, where inanimate objects are now becoming sensors that not only report but also analyze data. [For example,] the diaper in Japan that tells you not only when someone needs to be changed, but [also provides] an analysis which says if they’re at risk of a UTI. Well, that creates huge staff efficiencies and better care. I think the internet of things and the cloud in particular and how they are changing telemedicine and telehealth, and enabling better health care management for frail elders will be a positive, disruptive force in the seniors housing and care industry.

    The industry right now is still far away from that.

    That’s true, but the speed of change, even in our industry, may take your breath away, when it comes. The consumers are going to demand it. The payer or the risk taker is going to demand it, and there are some very innovative things that are going on, some of which will be announced at our conference later this month, others of which will be announced over the next year. I’ve found if you’re really invested in this, you don’t scream if from the rooftops, because quite frankly, this is experimental; it’s not like somebody’s written the textbook.

    When you say scream from the rooftops, are you talking about what you’re doing with technology?

    Yes, because you’re experimenting with major investments, and they’re not all going to work. There’s no guide book. What’s the most important area to invest; where are you going to get the greatest returns; what are you looking for, are you looking for returns for residents impacting how they and their family members feel about their experience, or something for your staff; are you looking to impress investors? So are we early adopters? Absolutely not, no question, and health care [providers] general are not. I totally agree with your assessment there, but there’s a great Bill Gates quote where he says when it comes to innovation, “we always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.”

    Do you think if you’re an operator and you’re not trying to innovate with technology, that you’re going to be left behind?

    It’s bigger than technology. If you’re doing this for the sake of being hip with technology, you’re probably not doing it for the right reasons and you’re likely to fail. You’ve got to first ask the basic questions, ‘How’s our customer changing? What is our customer really hiring our staff to do?’ In other words, you’ve got to be like Steve Jobs and Wayne Gretzky, you have to be skating to where the puck is going, not to where it is now, and that’s how you need to be applying technology.