By engaging residents through a variety of activities and focusing on clinical outcomes, Silverado sets a high bar for the industry.
By Matt Valley
An estimated 5 million Americans age 65 and older suffered from Alzheimer’s disease in 2013. Barring a medical breakthrough to prevent or slow the disease, that figure is expected to increase to 13.8 million by 2050, according to the Alzheimer’s Association, a Chicago-based non-profit health organization focused on Alzheimer’s care, support and research. While Alzheimer’s is the biggest cause of dementia, it is not the only one, say medical experts. Parkinson’s disease and strokes also are conditions associated with dementia.
One out of every three people age 85 and above has Alzheimer’s disease, so the importance of providing quality memory care communities for seniors with dementia can’t be overstated. Silverado, which opened its first community in Escondido, Calif., in June 1997, has emerged as one of the leading memory care operators because of its laser-like focus on clinical outcomes and passion for enriching the lives of seniors.
Based in Irvine, Calif., Silverado currently operates 30 memory care communities in eight states: Arizona, California, Colorado, Illinois, Texas, Utah, Washington and Wisconsin. Silverado serves more than 2,625 people through its memory care communities, home care and hospice programs.
Silverado Naperville, a ground-up development in suburban Chicago that was designed specifically for memory-impaired seniors, celebrated its grand opening on Dec. 5. The single-story structure, which can accommodate up to 90 residents, represents a milestone for Silverado. It is the 30th community the operator has opened.
An example of the company’s comprehensive approach to providing memory care is its Virtual Dementia Experience, which takes participants from the beginning to the late stages of the disease process. Participants wear vision-impairing goggles and noise-cancelling headphones to experience first-hand the health impairments associated with dementia.
Silverado is affiliated with academic institutions for research purposes wherever its properties are located. In California, for example, that includes the University of Southern California (USC); University of California, Los Angeles (UCLA); Stanford University; and the University of California, San Diego (UCSD).
Loren Shook, president, CEO and chairman of Silverado, has a rich background in managing and developing high-growth assisted living communities, behavioral healthcare systems and sub-acute care hospitals throughout the United States, Puerto Rico and the United Kingdom.
From 1973 to 1993, he served as president and COO of worldwide operations for Community Psychiatric Centers in Laguna Hills, California. He then founded Integrated Healthcare Systems Corp. in Aliso Viejo, Calif., and served as the company’s president and CEO from 1993 to 1997. He spoke with Seniors Housing Business about the company’s strategy as well as the challenges facing the memory care industry.
SHB: What is your growth plan for the company? How much bigger does Silverado want to be in five or 10 years?
Shook: Our vision of growth is all geared around the difference we are making in the lives of people. It’s not about how fast we can get bigger. We plan to open two to three communities a year, about 90 beds each. In five years, we could have 15 more communities. We plan to add a hospice program per year. This January, we will open a hospice in Austin, Texas. It will be our 10th hospice office. We plan to grow our home care service line as well, known as At Home Care. We have six At Home Care offices now. Maybe we will open an At Home Care office every other year.
Growth is never a straight line because we’ll get acquisition opportunities that arise. For example, in 2013 we made three acquisitions: one in Morton Grove, Ill.; one in Highland Park, Ill.; and one in Menomonee Falls, Wis. We opened other communities in 2013. We had much faster growth in 2013 than normal.
We can only grow as fast as we can develop and place the leaders in each of these new communities — whether they are ground-up construction or whether they are acquisitions — in order to create the culture that we have in Silverado. That is a culture that really enriches the lives of our residents, the families and the associates. That is the modulator of the speed of growth for us. Ultimately, we are going to be coast to coast.
SHB: What is Silverado’s criteria for site selection?
Shook: First of all, it’s the top 50 major metropolitan areas. We will expand it to the top 100. We look for the economics of an area that can support a private pay model of assisted living memory care. Then we look at how much service there is in the area for memory care, and how much of that product is doing what we’re doing at our level. So far, we haven’t found anyone doing what we’re doing at our level. About 20 percent of our business is referred to us from what some people would call our competitors. We prefer sophisticated markets from a medical point of view because that sophisticated physician and university group population understands our clinical outcome difference.
SHB: Will you consider a strong secondary market?
Shook: We wound up in Bellingham, Wash., which is definitely a secondary market (located approximately 90 miles north of Seattle). If AEW hadn’t asked us to assume operations of a community there, we would never have gone there. But Bellingham Memory Care Community is just hitting the ball out of the park. It’s performing very well.
SHB: Are the top 50 markets based on population or income, or both?
Shook: We conduct an age- and income-qualified demographic analysis. We qualify how many people are likely to have memory-impairing diseases in a particular market. We analyze how many people are in that 45- to 60-year-old age range. So, we look at it from both sides. Fairfax, Va., is a classic case in point. It’s a relatively young group that lives there, but they import mom and dad into the market. If dad has passed away and mom is living in Florida, it doesn’t make any sense for the family to find a place for mom in Florida, away from the family. The family brings her back to Fairfax, Va. We definitely conduct that kind of data analysis and take that very seriously.
SHB: What is the monthly fee Silverado charges for memory care?
Shook: Our charges are basically a flat fee charge instead of offering different price levels. We do that because levels are confusing to families. You can wind up with people being unhappy when they find out their loved one needs a higher level of service than they thought. That flat fee ranges from approximately $6,000 to $6,200 a month for a companion room, depending on the market. A companion room is one room with two beds — two people to a room.
About 90 percent of our rooms are companion rooms. Families will look into getting a private room for their loved one because they would want one for themselves. But the reality is that people with a memory-impairing disease get comfort out of a roommate that has been matched to them. It’s like having a roommate in college, without the heavy drinking.
We do have an extra charge for incontinence, which is about $400 to $450 per month because it’s enormously expensive to provide.
SHB: How long is the average resident stay at Silverado?
Shook: The average is 18 months. We might get somebody who moves in at the very end of his or her life and passes away in two weeks, while another person might live with us for 12 years.
SHB: What do we know today about dementia and Alzheimer’s disease that we didn’t know in 1996 when you launched the company?
Shook: We have done research with University of North Texas and USC that shows that an active stimulation program for people — music and that sort of thing — actually increases the cognitive functioning of the person who has the memory-impairing disease. It doesn’t cure the disease because the beta amyloid plaques destroying the brain cells and the tau proteins are still occurring. But we know that we can improve the functional level of people. Dr. Gary Small of UCLA has done research on this topic to support that conclusion.
If you take someone out of an isolated setting, such as a senior who lives alone, and you put them in a Silverado community where they get stimulation and socialization, the senior experiences success. We’ll do engagement activities, whether it’s the cooking club, gardening, or the philanthropy club where seniors go out and do things for the community.
SHB: When seniors come to Silverado, their medications are reviewed. What is the significance of that procedure?
Shook: We have 24-hour, seven-day-a week licensed nurses. Only nurses administer medications at a Silverado community. When they arrive at our communities, seniors typically are using 10 to 12 prescription medicines. Our nurses will review those medicines and go down the path of what can get eliminated. We have reduced the number of medications for each resident to 5.7 company-wide. Nobody in the industry has achieved this result. Whenever you take away a medication, you take away a poison. Every medication does a good thing, what it is designed to do, but every medication also has a negative side effect.
SHB: What is the biggest challenge for memory care service providers?
Shook: The biggest challenge for the industry is the fear of families to access our services. There is also a fear among professionals to refer people to us because they think of the bad experiences they had with that long-term care community 25 to 30 years ago that reeked of urine. As little kids, when they went into a long-term care facility they were afraid. They clearly weren’t welcome to visit grandma.
Some professionals will say to the families, ‘Don’t move in until the very end.’ You have people at home at risk of wandering out in the streets. This happens all the time. Somebody who gets lost overnight is dead the next day 50 percent of the time. There is data that proves that claim.
SHB: What do you like most about your job?
Shook: The most satisfying thing for me is the lives we change, and the appreciation we get from families, professionals and our associates. We do town hall meetings where we talk with the line staff at our communities. After one meeting, one line staff member came up to the management team and said, ‘You changed my life. I was homeless and nobody would hire me. You hired me and now I’m getting my CNA designation.’ (A certified nursing assistant must take an examination before he or she becomes a qualified nursing assistant.)
We change the lives of the families. A case in point is Marilyn Love, the executive assistant to Dallas Cowboys owner Jerry Jones. Her husband is Cecil. When Cecil first came to Valley Ranch Memory Care Community in Irving, Texas, he weighed 110 pounds and the doctors said he would likely die in a matter of a few weeks. She just wanted the best care for her husband. Three years later, my wife and I visit Cecil, who at 150 pounds is walking and talking about a recent visit from Barry Switzer, the legendary former football coach of the Dallas Cowboys and University of Oklahoma.