Faith-based mission

Kyle Nordine believes in what he does at the Northfield Retirement community

Story & photos by
JERRY SMITH

Kyle Nordine believes that some things are just meant to be.
That’s how he feels about his position as CEO and president of Northfield Retirement Community.
Brought up in a religious home and surrounded by a family with deep religious convictions, Nordine has always had faith in his life.
Because of that, Nordine was instantly drawn to NRC when the Board of Directors first asked him to interview for the job.
“I’m one of the very few administrators that are licensed in the state that actually got a call from the church to serve in my first job, much like a lay minister would,” said Nordine, whose entire career has been about serving organizations with a faith-based mission. “Maybe if I would have stepped out of one of those faith-based organizations during my career, I would feel a little bit different about that. But from the very first day I took my first job, I’ve been in that.”
That faith element has made Nordine and Northfield Retirement Community, with its nearly 400 residents and 185 employees, a perfect fit. Their life and business missions mirror one another.
“This is something we do that makes us different than other providers,” Nordine said. The Board believes in it and the community believes in it. It’s carrying on that mission that we’ve done for 40 years.”

In a 35C interview, Kyle Nordine talks about the senior living industry, Baby Boomers, and the future of Northfield Retirement Community.

Q: Are regulations in the senior living industry becoming tougher in the state of Minnesota?

A: Anytime there are issues that hit the media where care giving does not meet the expectation of the client, we’re held accountable. Accidents happen every day. We’re people taking care of people and sometimes things do not happen as planned. We’ve become a society that says none of these things should go wrong. And when they do, we should hurry up and make a regulation or unfunded mandates to make sure those things don’t happen again in the future, without truly researching the cause and effect.
We certainly don’t want to see people hurt or injured in any way. But, when people take advantage of vulnerable people, which happens more now than in the beginning of my career, there is more scrutiny. Because the government plays a bigger role as a payer, they now get to determine more of the rules.
In some parts of Minnesota, medical assistance in the state of Minnesota pays for 90 to 95 percent of all costs. In our case, it pays for probably about 30 percent of the cost. We’re the exception and not the rule.
Will we get to be there? Yes, that will happen. People will run out of money. They are living longer, we’re keeping them alive longer, and they are healthier.
Minnesota government says that if we are going to be the payer, then we are going to set the rules.

Q: How will the proposed healthcare reform impact senior living?

A: It’s going to change us and how we look at care for seniors. However, it’s so early to tell what all of those ramifications are because of the legislation bill being so massive and so many pieces to it. It’s going to have lots of effect, but we haven’t figured out the details of what that is. It will probably take 18 to 24 months for us to really understand what is going to happen within senior living options and payments.
As a small example of that bill, we have a whole new assessment process that has to go into place for the nursing home by October 1, 2010.  We have a mandate that we must have electronic health records in all of the nursing facilities by 2012. So, we know those pieces are coming, which means a lot of re-learning and a lot of money that most facilities aren’t set up to have those kind of electronic health records available. It’s a great idea, but how is it going to be paid for, in a time of budget reductions and deficits?

Q: Historically, Medicaid has paid half the cost of assisted living. Is that the model at NRC?

A: Assisted living is an interesting terminology. There really isn’t a true assisted living.  It is simply a descriptor of a set of services provided to the client. The state of Minnesota has a listing of 10 things you must comply with in order for your facility to be called assisted living. If you have those things, you can market yourself as that, but if you don’t have those 10 things, you can’t call yourself assisted living. You can, however, be something else that still provides housing and services for elderly people.
We have assisted living here because we meet all 10 of those requirements, but you’ll find in the future that most of this is really going to turn to simply being called housing with services.
People have rent, their room and board if you will, and then they have the care package brought to them at whatever level they need. The terminology of assisted living will hopefully go away because it is confusing the general public about what services are available.
The same thing is happening in housing with services/assisted living that has happened in a nursing home, that is people run out of money, they need a place to live, they need care services, and so consequently, the state adds a payment provision called “elderly waiver” to pay for the care services for folks who can’t afford to do that anymore.

Q: How long can that be sustained?

A: That’s a good question. When you have a state like we do and a country that is going through some serious economic times, what are we going to do? Next year, the biennium in Minnesota might have an $8 billion shortfall. We just saw a 5 percent cut in our services rates on the housing side this year alone, and that was for a $3 billion shortfall. Folks really need to think about this and they need to plan for themselves.  

Q: Is that scary for you as the CEO of NRC?

A: I don’t know if scary is the right term, but it will definitely be a challenge. But every challenge has an opportunity. A part of our opportunity is to do more care giving through technology. It is the place that will be the No. 1 change of all of the things that we do. We have to figure out a way for people to stay at home as long as possible, get the services they need, and in some cases, put back on the families some of those care responsibilities that have been transferred to care providers.

Q: How has this affected the decisions by you and the NRC board?

A: We’ve been blessed here that we’ve had directors and board members who are savvy about vision for the future and understand that you sometimes have to take a risk. You really don’t know what’s inside that crystal ball.
We’ve diversified ourselves from being a nursing home that was originally built in 1969 into more of housing with services provider. We’ve put in the Wi-Fi network across the campus and paid a fairly substantial amount of money to help people be more independent, not only on this campus, but also looking to the future.
We continue to plan for this type of expansion. We can’t put all of our eggs in this one basket and we have to partner with other folks and be diversified in what we are doing. Hopefully, we’ll get to a point where we’ve created an efficient economic living setting, where people don’t have to spend as much money on bricks and mortar of their rent as they do on the care services that they need for their mind, body and soul. That’s the piece that will cost the most due to the care giving labor component. And in the future, that’s only going to get worse because we just don’t have enough population on the workforce side to support the people who are aging and needing services.
This aging tsunami is going to come at us with disastrous proportions, with the Boomers aging and then not having a population to sustain that in the future.

Q: What makes offering choices a significant part of Northfield Retirement Community’s success?

A: Everyone wants the quality of life they’ve had in the past when they age and when they retire. As they move to downsizing their home, everybody wants to maintain the same quality of life. Our goal is to make sure people have as many choices and options available to them.
As you come to the campus, we want you to know that your choice is more than just going into the nursing home. We want you to know that we can meet your needs, doing everything from weekly housekeeping to offering a grocery store on campus to simple maintenance. We make all of those things possible for you. We go all the way up to checking your meds and taking your blood pressure in a housing setting. If you need nursing home care, great, but sometimes you have other options.
Being on the front end of those choices and saying maybe you ought to start at a planned location of living rather than waiting until you have a crisis event, where your choices all of a sudden become diminished, is recommended.
We don’t want people to have to be faced with huge living decisions because of a crisis, we want them to come and see all of the different living options we offer while they have the opportunity to reflect and plan for structured move to a new home.
We want people to work through a planning process and ultimately get them to be in a living option where they maybe don’t have to be in a nursing home. Not that it’s a bad place, but if they want to control their aging housing options, this is the way to do it. Our hope is to create those choices not only here, but outside the community as well. Some by education, some by information or referral, some by just visiting the campus.

Q: You mentioned Baby Boomers. Will that be a larger group of folks coming into this kind of setting than has been in the past?

A: I think it could, just by pure numbers. Unfortunately while we don’t have as many people who can take care of us, we may not be able to sustain economically the buildings of brick and mortar. If you ask most of the folks whether they would want to be in a nursing home, they would say no. They would like to live at home and have services brought to them.
The Boomers are going to say this is what I want, this is what I like and I’m willing to pay for it.  The big issue is how long they will be able to afford that type of life style and where will they go if they cannot afford it anymore. That’s part of our plan in working with the Boomers now.
We tell them to buy their insurance and make some good planning decisions and then let’s work through some education that says here are the housing and care options that will allow for you to live in your own home. Wherever that might be, maybe it’s your single family, maybe it’s a townhome, maybe it’s a cooperative or an assisted living building, but you always will get those choices to look at along the way. There will be an enormous number of people aging in place at one time all vying for services. That might not be the best description, but you just know it’s big. It will be a major wave coming through that will hit in a short period of time and it’s going to affect everything.

Q: How important is the education piece?

A: That’s part of our vision, to create an environment to educate not only our employees who work here and residents that live here, but also folks out in the community. Most people don’t realize that they are caregivers to their parents until it is too late. They don’t have the conversations with mom and dad or grandma and grandpa. They ignore the topic, then a crisis event happens and everybody gets turned upside down. It causes stress on the entire family.  There is a way to educate folks about doing this.
We want to be the provider and organization that helps provoke the early discussions and conversations about options, because we know if people come here better educated and better informed about what their choices are, that will make the transition easier for everyone and we’ll be able to give them a better quality of care.

Q: What led you to take that education approach to help set people up for the next 20 years?

A: We made this decision as part of the strategic planning that was done not long after I came here in 2002, setting up those principles and those strategic areas that we want to focus on and become experts in those arenas.
You’d be very surprised by the number of people who actually live in the community of Northfield who have no idea about Northfield Retirement Community. They’ve never been here, nor do they have any idea of what kind of services or choices they have.
So, how do you make that happen? Well, you have to educate them. They have to know what the issues of aging are out there and that’s a part of the business that we want to provide for them. That’s what your magazine is for, to educate people. That’s the only way folks get to make good decisions and good choices and to plan.
In my 30 years in this business, I’ve seen folks who have done little or no planning and I’ve seen families broken apart by doing the wrong thing or because all of the sudden they are faced with a crisis event. It’s devastating.

Q: With the economy the way it is now, have you had to market NRC more to compete with other retirement options?

A: I would say yes, we have had to market our services more for the competition piece. The economics have changed the landscape of what is out there. People are unable to sell their houses, which means they can’t rent a place from us, which means they can’t buy services from us. And consequently, then they have issues that get them closer to that crisis event if they have delayed planning. So we’re trying to educate them.
We really try to provide a back drop of information for people and tell them not to wait so long, because those choices aren’t going to be there for you if you wait too long within that setting.
As a strategic issue, from our board’s perspective, we’ve had to rethink how we can help create a solution for folks. How can we help the economic situations of some of the people who are quite frankly going to be our clients and get them here sooner so they don’t have to feel like they’ve waited too long.

Q: How has technology changed the senior living business?

A: I’ve come from a background that in my 30 years we’ve always written things down by hand. Now we have electronic ways to do that, which makes charting much simpler. This will get more sophisticated as time goes by, but there is a cost for having the technology.
We know that there are companies now that offer voice recognition systems that allow nurses to talk through those charts rather than hand writing all of the medical information. Going to a paperless setting on the nursing home side cuts down on time and allows the staff to spend more time with the residents and families. 
On the housing and services side, we’ve gone to a Wi-Fi network that now allows us to use walkie-talkies to communicate with one another within the building, so that we don’t have to try to run and find a staff member for support or help.
And ultimately, doing what we’re doing with the folks at Healthsense™ now and looking at the e-Neighbor™ system, which is basically a set of sensors that help gives us predictability of how people’s lives are changing physically. It can tell us, family members, or other medical staffs how often are they opening their refrigerators? Are they eating? Are they sleeping longer than they normally would? Those kinds of things that are able to have on motion tell us if something is changing in the daily routines. The idea is to create the predictability that we can catch a major crisis issue before it happens.
Can we stop people from falling down? No, we can’t do that. However, once they fall down, we want to know that they are not able to get back up. The longer they lay there, the more problems that can happen. That translates to more cost if all of the sudden they have to be taken by ambulance or if they’ve laid there long enough that they ended up with a pressure wound or worse. The dollars just grow exponentially when those things happen and the longer you are without help or attention.
The sensors are for safety, but more importantly for the predictability of care. The technology that we are able to use now within the housing side, for example, we can do a biometric set up, where we can basically take peoples’ blood pressure, their pulse, we can take their blood glucose for people with diabetes, feed it into a machine and the computer spits out exactly what’s happening and any irregularities. It tells us about the predictability of whether they are having a urinary tract infection or blood-sugar issues that might cause them to become unconscious.
Those things didn’t exist 30 years ago. They are just now coming to the forefront, to the point that we know of a manufacturer that actually has a sensor that goes in your shoe that can help determine if you are at a higher risk of falling. All of this is happening because of the Boomers getting older.
From that perspective, technology has made it much better in terms of us taking care of people. On a different side of the ethics argument, we’re also making sure people are living longer. I was educated as a hospital administrator, as well as a nursing home administrator, so I know the other side of each provider. Technology and what we can do right now to keep people alive is unbelievable. And it only gets better every day.
But, can we sustain that? How long can people live or how long can we keep them living. 
So, we have to figure this piece out on this technology, and if we can get it to a point where it’s affordable and efficient and we can help people put it in their own homes, we will have made a great stride.
The biggest challenge of technology is for the caregiver. What about the social side? The one-on-one we’re having right now. What are we going to do when we can’t have that? Will social networking become the way we do that?
We have very, very different pods of culture of how we’ve learned to deal with technology on a social medium. My grandparents would have probably nothing to do with a cell phone or email. They used to have the old ring phone.
Our kids are already learning keyboarding before they are out of sixth grade. I didn’t learn keyboarding and typing until I was a freshman in high school.
So, how are we going to bridge that gap of the social networking phenomenon when we don’t have enough people to have a one-on-one conversation in the future? Will we just become a bunch of mechanical socialites?
And then, how will technology help the folks who need physical care? We know within our industry that there are a number of organizations, particularly in the European countries, that are now working with robots and mechanical pets that have made companions that are technology based — robots that will actually turn you over in bed.
Northfield Retirement Community, as an organization, is now on Facebook. I would have told you three years ago that this would never have happened and now we are there. We’re still looking at the issues of Twitter and whether that works for our organization and then how does we communicate that with our residents and how will our activities and our structure change? These are questions we need to be asking our family members and residents. How does this work for you? How does this meet your needs from a quality care standpoint?

Q: Has there been any pushback with the technology and future technologies?

A: We have had some pushback. Not so much a negative reaction but one that requires reassurance. We have a culture of people who went through the issues with the Germany and Hitler. They were filmed and listened to, and so one of the things we had to do was to reassure residents and families about the sensors was that it is not a camera, it’s not a listening device, it’s simply a sensor that detects motion.
The parameters that are set up as to when it calls us or family members is all determined by the family, in consultation with us. It’s not set up by us, and it’s not set up by the government. You tell us what you want it to sense and when you want it to start calling the appropriate staff or family member. That’s all set by the resident and family members. It’s a constant reassurance about that. At some point in time, it will become the norm.

Q: With the expansion and all that is going on here, has NRC remained green and is that important to you?

A: We’ve tried really, really hard to remain green. We’ve created lots of retention pond areas and garden spots. We’ve actually written a grant for a rain garden that we’ve put in as part of staying green. We can’t just have black top and concrete with the buildings we’re making. We’re working with partners with materials we use that are also green in nature as well.
We’ve talked with our board of directors about wind energy, to use that for our campus. We’re not as big as Carleton or St. Olaf, but we certainly want to see if there is a way we can find a solution that helps us in energy usage.
We’ve looked at a couple of possibilities of green roofs, but we just don’t have the expansion size to do it. It’s always at the forefront of what we do. So everywhere we could to make that happen, we’ve tried to make that happen.

Q: What has been the biggest change in the industry in your 30 years as an administrator? Since taking over NRC?

A: The biggest change has been the focal point from the care of our seniors.  We used to believe that the only option was a nursing home stay for most elderly.  But the housing and care options that currently exist and the menu of options that people have to choose from have created a plethora of alternatives for many aging individuals to select. This is caused by good providers listening to the people who are coming for information and providing feed back to the care givers on what types of services, housing options and amenities they are willing to pay for in their retiring years. We use this phrase here: right place, right time, right people. If you have those three things in place, you can do a lot of great things.
As far as here at NRC, I would say probably the biggest change is the whole focal point about the technology and being on the forefront of this fantastic journey. And, understanding and having a vision that this is the way we have to do things now and more in the future.
You can build bricks and mortar to meet peoples’ needs, but at some point you have to go beyond that and make something new and innovative happen in the market place.

Q: You were on the Red Wing city council. What motivated you to run?

A: I had lived there long enough, and you know as well as I do that if you live someplace long enough, it becomes a part of you. There was a little bit of a challenge there for me because — and this might be a little bit like Northfield as well — if you weren’t born and raised in Red Wing, the assumption was you couldn’t be elected into a government role.
Fortunately, our sons were raised in Red Wing, as well as our other two children being born there. I had just gotten to the point where I said I can make a difference here.
I felt like the council and the organization as a whole wasn’t doing the best job of creating partnerships with business and providing taxpayers with ideas about how best to make that community grow and prosper.
My thought was that we could do this better if we partnered together. That’s what my platform was. Let’s figure out how to have these conversations and how to make this an even greater place to live than what was already in place.
Interestingly enough, when I came to Northfield, I saw a lot of the same things here that I experienced in Red Wing when I was a council member. The same things that we are going through now in this community are similar to what Red Wing went through, and that is, what do we want to be?
I only served two years, but I felt I made a difference. In some ways I was sorry to leave from that perspective, but I knew this was the right move for me and our family.

Q: Has your experience as a council member in Red Wing affected the way you interact with the council here?

A: All of our building projects have had to go in front of the city council and planning commission. And there have been a number of other issues that I’ve tried to weigh in on. As you live in a community longer, you get to know these volunteer servants of the public trust. They are your neighbors and people you talk to each week.
Having sat on the council, I know what some of the good and bad stuff that they have to go through. I know what it’s like to have to sit in a budget meeting and a council meeting for hours. There will always be someone along the way that will say you didn’t do it right.
In some ways, I think everybody should have to experience that, especially if they are decision-makers. There are probably some people who want to but who will never get elected for whatever reasons. I really think you have to give these elected leaders some positives and thank them for their service and for trying to do the right thing to the best of their ability.

Q: What will the next chapter of senior living bring?

A: Flexibility by the providers. Planning by the individuals and their families. And maybe not necessarily in this order, but economics will be huge and technology will have a part to play in how well those economics play out in the state and the nation. These are the four big keys of what we do and what will happen with senior services.
In this service industry, we went from a care model to a hospitality model. We now provide hospitality to people because that’s what they want. Are we any different from a glorified extended living center or hotel? Probably not. We’re providing people with places to eat and sleep and go about their daily life. We just have a different menu to offer them than perhaps a hotel does.