Lument: Assured Senior Living: Pioneering a New Vision for Seniors Care

By the time Francis LeGasse and Brian Turner were 27, they had a firsthand understanding of how stressful caring for aging loved ones can be. Their families had struggled to find quality care for LeGasse’s and Turner’s elderly grandparents, and the resulting anxiety and frustration sharpened disagreements among family members about their shared responsibilities. LeGasse and Turner came away from this emotionally draining experience convinced that the institutional model of care, no matter how well-intentioned, failed both caregivers and loved ones. “It ends up generating strife at a time when families should be coming together to support their loved ones,” LeGasse says.

The trauma of caring for elderly parents is common enough—and most families are quick to leave the pain and frustration behind after their loved ones die—but not LeGasse and Turner. They were inspired to find a better way to serve older adults. “We were both attracted to the idea of entrepreneurship,” Turner says. “We felt certain we could do a better job than other people.”

In creating Assured Senior Living, Turner and LeGasse, who had run track together at the University of Michigan, focused on providing the love, compassion, purpose, and quality care that caregivers want for their loved ones—and that their loved ones deserve. They realized that, on a fundamental level, the key to delivering this standard of care is retaining an exceptional staff and reducing the caregiver-to-resident ratio, allowing a level of personalized care and attention that cannot be realized otherwise.

This priority, in turn, led them to a residential model of care. LeGasse and Turner have developed a series of individual senior living homes, often with a live-in staff, that accommodate between eight and 12 residents. They have all the features of the typical suburban house—living room, dining, room, kitchen, backyard—but are designed—for instance, with wider Americans with Disabilities Act (ADA)-compliant doorways and hallways—to facilitate the delivery of care to residents and enhance their quality of life. Assured built its first home in 2010. Today, it has 32 homes serving 290 residents across Denver’s suburbs, covering memory care, assisted living, and traumatic brain injury.

Turner and LeGasse sat down with Lument to share what they’ve learned about the residential model of care over the past 15 years—and what it’s taken to translate this vision into a viable business model.

Lument: From a resident’s point of view, what are the advantages of the residential model?

LeGasse: A majority of Americans spend most of their lives in traditional houses—and so our homes have the advantage of being familiar. This makes the transition to senior living smoother and less disorienting. And because our residences are embedded in a suburban neighborhood, it’s easier for seniors to be part of the local community. They can take a walk in the neighborhood or have family and friends take them to local restaurants and shops.

Turner: This familiar environment is especially important for people with dementia. A home is easier for them to navigate than an institutional setting. There are no long hallways that can pose a cognition challenge. Having this level of independence is itself empowering. And residents with dementia can gain a sense of purpose by contributing to the familiar tasks that are part of living in a home, whether it’s setting the table or folding laundry. With oversight from our caregivers, they can exercise the skills gained over a lifetime. This continuity is really critical, and it’s one that’s difficult to replicate in a traditional facility.

Lument: Your example of doing household chores highlights the importance of close interactions with staff in delivering care that’s meaningful to residents. This clearly is another advantage of the residential model.

Turner: That’s correct. We maintain a ratio of one team member to four or five residents, which is unheard of in our industry. And in many of our residential settings, we amplify this closeness by providing onsite staff housing, often a small apartment, for a nominal rent. As a result, we have long-tenured direct care team members. From a business perspective, this is a distinct advantage. We have much less turnover than the typical senior living company, but continuity also has tremendous value for residents and their caregivers. The close relationships they form with staff over time make a tremendous difference in how they experience care. You can’t do that if you have employees rotating in and out of the facility.

Having staff living on site proved an unexpected benefit when COVID struck. It was really easy for us to isolate each home and limit the number of people coming onto the premises. As a result, we had only 25 cases of COVID over the three years we monitored it—and none of them were serious.

LeGasse: In addition, because of the consistency of our staff, they are better able to anticipate the needs of our residents. There’s no pushing a call-button and waiting. Our staff know the pattern of our residents’ lives. They know what residents like and dislike and what does and doesn’t work for them.

Lument: You’ve covered the advantages of the residential model. What are some of the challenges?

LeGasse: Decentralization is the big one. With 32 individual homes, we have to be able to keep a lot of balls up in the air. There are different licensing requirements, maintenance issues, insurance policies, and the list goes on and on. When you’re working in an institutional setting, you step into the building once, and you’re there all day. We’re constantly on the move.

In these circumstances, communication and collaboration are critical. We rely on a HIPAA-compliant app, Serenity Connect, that brings together everyone involved in the care of our residents. Anyone can provide real-time updates, including our residents and their families. The app gives us a global sense of what’s happening across our communities and allows us to drill down to a specific home or resident.

Turner: Another challenge is that when we propose a new home, we sometimes encounter NIMBYism (NIMBY stands for not in my backyard). Local residents are concerned about how it might affect their neighborhood. Once we start operating, however, that NIMBYism typically goes away. Our own standards are high—we want to have the best-looking house in the neighborhood—but we are also held to a high standard by our regulators and lenders. We are required to maintain our properties in ways that are optional for other homeowners.

Lument: Securing financing must also be an issue.

Turner: It took some education. We really like HUD financing. Being able to lock in a low rate for 35 years is unheard of, but we knew it was going to take a fair amount of effort to get HUD comfortable with our residential scattered site approach with staff living onsite. Lument’s Rob McAdams had taken an interest in us early on, and he provided the guidance about the numbers we needed to have before applying and what we had to do to demonstrate the value of our model.

LeGasse: Rob went as far as to invite HUD to spend two days in Denver to meet with us and visit our homes. That really flipped the game. They came away from the trip excited about our model and ready to do a deal. That whole experience, though exhausting, was validation for us. We ended up thinking maybe we really have accomplished something here! We have Rob to thank for that.

Lument: Most senior living companies begin with assisted living and graduate to memory care. Assured did the reverse. Why begin with memory care, which is typically perceived as more difficult to deliver?

Turner: Our perception has been that for a lot of operators, memory and brain care are afterthoughts, grafted onto assisted living. We wanted to shift the discussion around dementia. About 85% to 90% of people moving into senior living have some form of cognitive impairment, so the principles of working with older adults with dementia also apply in some degree to the larger population. In this respect, memory care provides the foundation for assisted living.

LeGasse: We talked earlier about how the physical environment of our homes in itself elevates care for residents with dementia—and this is true for all our residents. Our programming also contributes. We use yoga and music therapy developed by experts who understand dementia. We also train our staff on specific techniques that dementia expert Teeba Snow has developed to promote engagement with people with dementia. We are even exploring the use of virtual reality to stimulate recall and reminiscence.

Lument: Your willingness to try virtual reality seems to be indicative of another quality of Assured Senior Living: your insistence on staying on the cutting edge and questioning conventional wisdom. How do you keep up?

LeGasse: We decided early on that if we were to provide the best possible care for people who are aging, we would have to understand the aging process, and this means keeping up with the latest research. We also look to other sectors of the economy to see what they’re doing to better serve their customers. For instance, robotics have proven themselves in a number of industries. Transferring patients from beds to wheelchairs can be difficult for staff. Having a robot to assist them might reduce back injuries.

Turner: These days, researchers are delivering so many new insights into aging. It’s exciting to use that information to find new and better ways to deliver quality care.

Lument: Where is Assured going from here? What’s your next step?

LeGasse: We are looking to close one more acquisition in Colorado and then we will begin to look farther afield. And I think the success we have enjoyed so far positions us to be a little more vocal about how we as an industry need to challenge ourselves to go beyond what we know today.

Turner: Those who are aging now don’t want to age like their parents or grandparents did. It’s our job as providers to listen to that conversation now and begin to look toward models that match what seniors will want 10 or 15 years from now.