Senior Living Business: Q&A With Don Gilmore

Don Gilmore is president and CEO of Otterbein Retirement Living Communities, a not-for-profit organization that currently owns and operates six continuing care communities throughout the state of Ohio and provides management and affiliated services to two other communities. The original Otterbein community was built in Lebanon, Ohio, in 1912 for children and adults on land purchased from the Shakers. The children’s program was dropped in 1963. Otterbein Neighborhoods, a small-home model of nursing care, will open this fall. Gilmore is the third generation of his family to be involved in the senior living business. He has served as chairman of AAHSA, president of the New Jersey Association of Non-Profit Homes for the Aging, and is currently on the board of Momentum Health Solutions, a product designed specifically to allow residents in not-for-profit retirement communities to receive care at their home community.
What are your thoughts on current institutional care?
The system that we have is fundamentally flawed and broken. The system being used to care for frail elders is a health care model designed for short-term care in a hospital setting. These institutions are not places where anyone would choose to spend the rest of their lives. We need to find a better way, one that removes some of the institutional barriers that not only plague the elders who live there but also are a plague to the people who are trying to care for them — and who care for them heroically and at a great personal emotional cost.

How is Otterbein changing its approach?
We’re repositioning some of our CCRCs and developing several small houses, something that we think, over time, will give benefit. The concept is as much programmatic as it is physical, although the physical side is the platform that enables the program to be significantly changed. We’re not part of the Green House Project and have clearly chosen not to be, but the small houses will be much like the original Green House model. We’re developing seven locations in Ohio — 31 small houses for 10 residents each.
We’ll operate the small homes as independent units in little communities of 50 elders each. We’re building six communities — each with five houses on a cul de sac. The single house is on a small CCRC campus that has had patio homes, apartments, and assisted living but no nursing beds. The added small house will give that facility the full continuum.
We’re taking beds from our current CCRC campuses and moving them to the new neighborhoods, which are located in zip code and market areas from which we normally draw. That means folks will move closer to where they have lived, their families live, their churches are, and their friendships and relationships remain.

Will you operate the new approach separately from your traditional facilities?
We’re the first provider in the country, I believe, to take this model off campus and treat these small-house neighborhoods as separate, self-contained communities that do not have a mother ship, so to speak.
It’s very difficult to run the new model and a traditional, double-loaded corridor type of nursing home model, with its department structures and layers of managemet, at the same time in the same location with the same people. A completely different mindset is required.
We want to bring down the relative size of the nursing homes in our CCRCs to improve the ratio with our independent living apartments and assisted living units in order to reflect the natural "aging in place" stages that go on in a CCRC.
And through some remodeling, we’ll transform our remaining CCRC facilities into a high concentration of private rooms and more assisted living suites. That will begin the cultural transformation toward being much more elder-focused, as opposed to the traditional, clinical, health care model of current nursing home environments.

Are you phasing out your "clinical" facilities?
We will over time. Our flagship is a 900-resident community on 1,200 acres in Lebanon, Ohio, with 346 licensed nursing home beds. Nobody in their right mind would even think about building a 346-bed nursing home in today’s environment.
We’re removing 200 beds from that campus and redistributing them into the second-fastest growing county in Ohio. That also helps our staff, who won’t have to travel so far to get to work. So there are many positive aspects to this restructuring.
How will the small houses be managed?
It’s all designed around what I call "the rhythm of daily living." We’ll eliminate departments and have an electronic medical records system, which will be virtually paperless.
The elder assistant will be the key staff person — one elder assistant for every five residents in each house. Nurses will be more clinically oriented, similar to home care nurses. Medications, other than controlled substances, will be stored in a locked medicine cabinet in the resident’s room, much like in your own home.
The elder assistant will prepare all the meals so, in the morning, residents will smell the bacon cooking and decide whether to have scrambled or fried eggs. I can’t produce that environment in a 125-bed or even in a 60-bed nursing home with a distant kitchen.

Do you see this approach replacing the traditional institutional model?
I started in this business with my parents in 1963. When I look in the mirror today, I ask myself whether I’ll be the victim of what I create or the beneficiary.

In the short term, this philosophy may not be very popular among providers, as there’s a huge inventory of traditional medical-model nursing homes. So it will take time — but the consumer will demand it.