SilverFox Broadband's Blog

The government has announced a number of tech-based programs that will help improve health and care coordination in the United States. Two examples of these programs are the Electronic Health Record (EHR) Incentive Program and Accountable Care Organizations. Since these changes affect everyone in the country, not just seniors, we’re going to give an overview of what these changes mean to the average person.

The EHR Incentive Program, otherwise known as Meaningful Use, incents eligible hospitals and providers to meet and report on certain objectives and quality measures in order to earn thousands of dollars (up to $63K for providers, and around $2M for hospitals) in incentives over the next 5-6 years. While initially the program does offer financial support to eligible hospitals and providers for adopting technology, the overall goal is to better coordinate care to reduce costs and improve the quality of health care in America. Many of the objectives are focused on sharing patient information electronically between providers and systems, as well as engaging the patient in his or her care via electronic patient portals. In fact, it is likely that the next stage of Meaningful Use (scheduled to be released this summer), will hold health systems accountable for engaging at least 10% of their patients in actually logging in and using the electronic portal. This means that their patients need Internet access to use the portal. In addition, many of the meaningful use objectives focus on care transitions, requiring paper or electronic summaries of the care provided be given to the patient to share with their next provider or care facility.

Starting in 2014, those providers and systems that do not meet the Meaningful Use criteria will begin receiving reduced reimbursement payments from Medicare, with the reduction rate increasing over time. Eligible hospitals and providers adopting certified EHR technology and meeting the Meaningful Use requirements will be actively looking to partner with facilities that have also adopted these technologies as part of the requirements to have a qualifying program.

Summary: Hospitals and physician offices will be adopting EMR and trying to optimize its usefulness in order to maximize their government reimbursement.
What it means to you: Your health records should become more accessible to all care providers, making care more effective and efficient, ultimately lowering costs.
What it means to senior housing: Health care providers will want to update their records in real time, so on-site medical staff and residents will need a reliable Internet network to do so.

Another major change in health care is the introduction of the Accountable Care Organization (ACO) model. In the ACO model, the patient is assigned a care team that receives a bundled payment for treating the patient. The care team is typically made up of a full spectrum of providers: physicians, mid-level providers, nurses, therapists, pharmacists, dieticians, etc. The goal is that when a patient needs care, he or she can get a timely appointment either with their primary care physician or a mid-level provider to treat the condition early and prevent costly emergency department visits or hospital admissions. In addition, quality metrics are used to proactively monitor patients with chronic conditions. For example, a nurse may call a diabetic patient once per week to confirm at-home blood glucose monitoring results and discuss proper foot treatment to prevent the condition from worsening. Because the ACO model pays for services via bundled payments, it is advantageous for the care team to coordinate efforts and play a proactive role in the patient’s treatment in order to best utilize the payment. A monthly nurse call is much cheaper than an emergency department visit and subsequent one week hospital admission, and also results in a healthier and more engaged patient. A key piece to the success of the ACO model is the ability for all members of the care team to be able to communicate in a timely and effective manner, putting electronic health records (EHR) at the foundation of the model’s success.

Summary: Your healthcare is going to come with a ‘money-back warranty’ of sorts. If a hospital fixes you and you don’t stay fixed, then they won’t get paid to do that work a second time. This incents them to do a thorough job the first time and to emphasize preventive care and chronic disease management to keep you healthier in the first place. It also incents them partner exclusively with providers that have the necessary technology to treat the patient – whether it means more in-house services or just interoperable 3rd party providers.
What it means to you: Your health care providers will be offering more robust services and want your help in keeping your medical information up to date across all levels. They’ll work proactively to keep you healthier instead of just fixing things when they break. They’ll also be directing you to care providers that have the technology that ensures they can communicate and collaborate together.

What it means to senior housing: ACO’s will need to work closely with senior housing to make sure patients’ care is consistent once they return home home. This will involve much more communication and collaboration than is currently happening. Senior housing communities will need to leverage technology to keep this from being overly time-intensive and inefficient. Physicians may recommend their patients away from communities that don’t have the technology pieces in place to facilitate this collaboration and communication.
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Properties are failing when it comes to technology, both for the staff and the residents. Occupancy and profitability are the primary challenges to any senior housing community, but instead of property managers using technology to fix these issues, they are focusing on the other fundamentals that have affected their properties for a long time.

Currently, the top priorities property managers typically focus on are:

• Reducing costs, including staffing, to increase profits
• Increasing activities to engage current residents and attract new ones
• Reacting to ever-changing reimbursement rates and economic stressors by guessing which new marketing methods will successfully fill empty beds

All of these areas are important, but the solution to occupancy and profitability will not be found using these same old strategies. Investing in technology is the critical missing component to fix these problems at nearly every property right now and will be even more critical in the future. Properties need to realize that caring for their residents isn’t just about high-touch; it’s also about high-tech.
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SilverFox Broadband has purchased a Chicago-based IT consulting company, Wave-n-Wire Inc. SilverFox will use its experience in building scalable, remotely managed IT networks and WiFi expertise to expand the capabilities of Wave-N-Wire to its existing clients and other small to mid-sized businesses in the Chicagoland area. Wave-n-Wire currently provides cloud, server, desktop, and network services to a wide range of businesses typically in the 5-50 employee range. With the additional resources and experience of SilverFox Broadband, Wave-n-Wire will also be able to expand its capabilities to offer fixed-cost, turn-key IT deployment. This gives businesses the ability to budget, plan, and scale their IT resources at a fixed per-user monthly cost that includes all hardware and support. Wave-n-Wire will also offer part-time strategic CIO services for companies going through a transition or in need of a more strategic IT vision without the need or budget for a full-time CIO.

SilverFox Broadband will continue to focus on providing Internet, TV, and phone service to senior housing communities nationwide and will be leveraging the Wave-N-Wire purchase to also provide IT consulting and EHR/EMR services to the senior housing industry.

Does the thought of losing all of your photos, music, and documents on your computer bring upon a sudden feeling of uneasiness? The loss of this data could be devastating and cost you thousands of dollars more than just the computer that stored the information.

I recently had a mishap with my computer. My hard drive was completely erased. I lost 4,803 songs, wedding pictures, the rest of my pictures not on Facebook, and eight years of email. It also included years of documents, including expensively crafted legal agreements, consultants’ results, and other documents that had taken hundreds of hours to prepare. Once I started adding it up, I was shocked at the dollar value of the data I had on my computer, not to mention the priceless pictures. Fortunately, I was saved by a cloud.

The term cloud is thrown out a lot these days; but it essentially means any Internet-based service where the real computing or work doesn’t take place on your computer. One of these cloud services is file storage and computer backups. I had one of these services running on the background of my computer for a couple of years, and thanks to it, all of my data is back where it should be – on my computer.
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Over the past year, I’ve shared information on Internet access’s impact on residential living and retirement communities. I’ve covered everything from compliance to the financial impact of offering Internet services as an amenity. Savvy business people subscribe to content that keeps them informed about trends to stay ahead of the curve in their respective industries. As a business owner, the most important content I want to review is from my customer.

When interviewing Ken Larson, a resident at a veteran’s home, the first thing that came to mind wasn’t how important access to the Internet was to him, but how important it was that the facility was kept immaculate, affordable and comfortable. The second thing was how he represents the next wave of seniors entering retirement communities.

Meet Ken…

SilverFox:
In your opinion, what are the pros and cons of offering broadband in retirement communities?

Ken:
As a 66-year-old disabled retiree living in a veteran’s home in Minnesota, I have observed the impact of having broadband and Internet, as well as Wi-Fi throughout the campus for 180 veterans here, ranging in age from late 20s to late 90s. It has permitted them to stay in touch with their families, the news, sports and the world at large. It also provides entertainment.

Many here are severely disabled so it is a great asset to them. Others have furthered or completed their education online and located work, permitting them to leave. Training is provided and many own their own PCs. I do not own my own hardware for reasons I shall explain.

Sadly, internet use can also promote vegetation, compulsive gaming and, for those with sleep disorders or gambling addictions, a continued tool to further their maladies.
There are residents who don’t get enough exercise, which leads to obesity. And there are some mental health challenges for some individuals here, 20 years younger than I, who are physically capable, but who never leave the facility grounds and rely on the Internet to enable their lifestyle, which in this case isn’t healthy.
Due to budgetary limitations and HIPPA laws, which prevent most forms of interference, if the individual is not willing to accept help at a Federal VA Hospital, he is not treated for health challenges such as these.

It is unfortunate because the town here is unique. There are 25 miles of scenic trails along rivers and woods, and the area has much to offer. Yet few residents investigate. They fall into a culture of control and habit.

I use the Internet two hours a day in the morning and evening. I use the PCs that the facility furnishes. Afterwards, I depart for a three mile walk to the public library or client locations, spending 12-14 hours away, volunteering for small businesses, hiking, fishing, photographing and the like.

Occasionally, I use library or client hardware while away.

SilverFox:
How did you figure out a way to maximize the potential of the Internet instead of falling into some of the more negative habits you mentioned about some of the other residents?

Ken:
I live in a state run veteran’s home in Minnesota. The facility provides food, lodging, medical and dental care to veterans, as well as Internet service via Wi-Fi throughout the campus. It doesn’t allow residents to conduct business on the premises. Because I’m passionate about consulting small, minority-owned, veteran-owned and women-owned businesses, I was motivated to leave the facility and provide face-to- face, as well as online work, and make presentations to community organizations. I spend about six hours a day at an office that the county gives me free of charge as a non-profit organization at the local library. I don’t profit in any way from my help in developing these enterprises and serving the community.

SilverFox:
To what extent does the Internet enable your lifestyle? You seem to have a rich social life online and in real life. Your LinkedIn Network, for example, includes more than 500 people. What does that network mean to you?

Ken:
I grew into LinkedIn and networking as a function of my SCORE and Micro mentor volunteer work after retirement.

I am a two-tour Vietnam veteran who enlisted in the Army after completing high school and two years of college at the University of Minnesota. Upon returning home, I spent 36 years in the aerospace and defense business working contracts and program management on many of the weapons systems our troops are using today.

I retired for health reasons in 2005. As a natural extension of my career, I began volunteering with the SCORE and Micro Mentor Foundations, I started advising enterprises on how to get into the field to take advantage of loans, set asides and other advantages offered by the federal government to small, veteran-owned, and minority-owned and women-owned business, and those residing in Historically Under Utilized Business (HUB) Zones.

In order to manage the high volume of inquiries in federal government contracting, I set up a Google blog as an extension of my volunteer work that blossomed into a website. It costs $10 a year to buy and convert it from a blog to a domain in my name. This blog contains the basics of entering and succeeding in the government contracting venue, as well as my books and articles on the subject for download via Box Net, also a free application. The idea was to refer clients to article links at the site to avoid being repetitive to new clients, while still keeping myself available for specific inquiries and problems.

I linked everything together on LinkedIn and began answering questions using the “Answers” feature, as well as registering to use other free applications for networking websites to see how that could benefit my work. I’ve also used Twitter, BlogCatalog, Facebook, Widgetbox, Friendfeed, Ning and similar free applications on my site.

The AdSense Feature added cash flow. I gained nearly 30% of my clients from LinkedIn or LinkedIn related networking.

As a result, I’ve seen heavy traffic and good efficiency in supporting more than 5,000 counseling cases within the last seven years with virtually no expense to me as a volunteer working for non-profit organizations. I received a SCORE National Achievement Award in 2010 for volunteering 1,600 hours to 500 small businesses that year.

SilverFox:
You mentioned that you are an advisor to several retirement communities in development and that you have helped to develop about three dozen communities over the last three years. Do you recommend that they provide Internet as an amenity?

Ken:
I think it is important for seniors who have become adapted and who use it. For people who aren’t well mentally or have obsessive-compulsive tendencies, it can drive them to abuse their mind. If a facility doesn’t have the policies in place to manage or the correct license to deal with these health concerns, those residents may be at high risk. The facility they live in cannot tell them not to use the Internet, but they can install a system that blocks certain sites that tend to be traps for the residents of these facilities.

Bottom line—Striking the right balance is important with regard to these communications technologies, but it is a personal decision, much like other venues in our free society. Thus, facility management can only do so much.

SilverFox:
The vast majority of seniors utilizing the internet do so wisely. It is an important tool for them to maintain connections with family and friends as well as to continue to challenge and stimulate themselves intellectually. Ken is a wonderful example of all the good that can be done by seniors when they are provided with access to the internet and other modern tools of technology.

Ken brings up valid concerns about the challenges that the Internet brings to retirement communities, but ones that can be mitigated if the community properly manages their network. For example, a firewall or filter can be put in place to limit certain online activities. I’ve done this for the VA Hospital in Iowa City and had requests to do this from religious colleges. Residents who aren’t able to actually go out can use the Internet to communicate with family and friends.

Bottom line—it’s more important to provide options. This generation of retirees is not retiring from careers where the use of technology was primarily only used in the tech department or where executives ran conglomerates and never had to use the Internet. Instead, like Ken, many of them, inspired by their own career ambitions, have become adept at using technology as a means to communicate.

In my last blog post I began talking about how multifamily property owners can benefit from providing high speed Internet as an included utility. In this post I will cover specific formulas you can use to see if providing Internet services is the right choice for you.

Cost reduction through technology

There are a number of ways that a property can save operating costs through proper integration of an internet network. This could be through building automation, more efficient rental collection processes, and eliminating IT redundancies.

When properties are wired with Internet, they can enjoy a number of technology advancements that not all properties can have the benefit of. These technologies include wireless monitoring of key mechanical systems throughout the property, such as air conditioning condensers and elevator maintenance. As more automation and green technologies come about, many are relying on wireless Internet access for their communication and optimization. With a wireless Internet network, the property can take advantage of the savings and efficiencies these systems offer.

Some Internet providers also allow the integration of their rental portal to the property’s systems. This could allow the property to post community activities or alerts. The community activities could further enhance the participation of residents and help attain the goal of higher resident retention. On the alert side, the system could alert residents of an emergency situation.
With some companies, the Internet portal can be integrated with rental payments. This can either be manually integrated or automated with property management software. This allows the property to turn off or slow down Internet service for renters that haven’t paid their rent. Affecting the lifeblood of these residents, their Internet service, ensures action from them.

Nearly every property now relies on Internet access for their property staff as well. If a property is offering the service to its residents, then in most scenarios that same Internet connection can be used to provide service to the staff. This reduces Internet costs to the property that could be as little as $50 per month or as much as several hundred or thousand dollars per month. In some scenarios the Internet provider can go one step further and assist in management of the property’s IT network, further reducing costs.

Marketing effect

Furthermore, offering Internet services assists in marketing the property, making it easier to fill apartments. Within senior housing, 90% of incoming residents consider WiFi to be a highly desirable amenity (survey conducted by Mather LifeWays, Ziegler and Brecht Associates). With that being the case in senior housing, imagine the demand in traditional multifamily properties where internet usage is several times higher currently. Some potential renters are currently pre-screening in their apartment search by looking for apartments that include Internet with the rent, which is why nearly every apartment search website has Internet as one of the selectable amenities. By offering Internet, it increases the potential audience that the apartment listing is reaching. Potential renters will also factor this into their overall budget. While a property with Internet may be listed for $10 or $20 more per month, the resident sees the value as $50. This makes the overall property cost $30 to $40 less than the competition without Internet.

Benefits for property owners that offer Internet services:

• More renewals because you are controlling their utility cost increases:
Lower cleaning and apartment turn costs

• Fewer apartments to fill:
Lower marketing costs

• Meets requirements of more renters:
Overall utility cost-conscious renters
Renters looking for Internet
This leads to a larger population looking at the properties, making it easier and quicker to rent

Higher net income = higher valuation

With every reduction in cost or increase in revenue, it positively affects the net income for the property. Property valuation can be a function of the CAP rate, which is directly affected by the net income. An increase of $5 per month per unit on a 150-unit property with a CAP rate of 6% can result in an increase in valuation of $150,000. While in contrast, the cost of the network may have only been $30,000 to install. That is a return on investment of 500%.
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For many years Panera Bread has been a critical stop for business travelers in the field for one reason: they had free WiFi at all of their locations nationwide. Travelers knew they could stop at any Panera Bread location for a cup of coffee or some lunch and get connected. This drove business for Panera and anytime you visit a Panera you’re likely to see several people with their laptops open. Last year, Starbucks and McDonalds followed suit and opened up their WiFi to be free to guests as well. These companies all understand that Internet has become a utility for people nationwide and that they can drive revenues by offering this service to their guests.

The Internet is a standard tool.  Many B to C companies have taken notice of this need and have used it to enhance their customer service practices, causing both direct and indirect revenue increases and a better consumer experience.  There are a number of reasons it makes sense for traditional multi-family properties to provide Internet services to their residents as an included amenity in their portfolios, some of which are:

• Impacting residents’ cost of living
• Increasing resident retention
• Decreasing late rent payments
• Increasing revenues

Most renters actually consider Internet and  Cable to be a utility similar to  water, electricity, heat and gas.  When a potential renter is considering a property, they take all of these into consideration when calculating their total living costs.  The same is done for current renters.  If there is a substantial increase in one of these costs during their lease, this affects their overall living budget and their view of the cost-effectiveness of  their dwellings.  These cost increases will force residents to look at moving, even if there wasn’t an increase in the base rent.
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Tech-savvy Seniors are a booming market. Seniors are consumers of gadgets like the Nintendo Wii and competitive users of the Internet. Is your senior housing community prepared to meet the demands of such tech-savvy residents?

As a professional broadband service provider for Senior Living facilities, it never ceases to amaze me how setting up proper access to the internet isn’t a priority for many of the senior living communities I encounter. Seniors may not use the Internet as much as their grandchildren, but that is changing. This year, some of the nearly 80 million Baby Boomers in the United States have turned 65 and are now “officially” senior citizens. Even the U.S. government has plans to bring high-speed wireless to nearly all American households as a part of the broadband stimulus program. There are so many incredible resources on the web for everyone, including seniors, that it only makes sense to make access easy within senior living faculties.

Five reasons for seniors to get online:

1. Save money – You save money by eliminating the expense of paper checks, envelopes and stamps—not to mention the time that you save paying bills from one place online. You can also save money by comparison shopping. I recently purchased a white board for my office on Amazon.com for $50 with free shipping, compared to spending $100 at Office Depot. It also saved me the time of making the trip.
2. Save time - Many tasks are quicker and easier online – online banking and getting the groceries! Seniors can opt into online bill pay from most financial institutions, and they can even manage their prescription and medical supplies via the web. Not to mention shopping for other goods (like a white board).
3. Stay in touch – The Internet provides free and easy ways to keep in touch with friends and family … no matter how far away they are. Seniors can use the Internet to Skype with loved ones and to communicate via chat applications and email. Seniors who have the iPad II or a newer laptop can video chat using the latest in conferencing technology with their built-in video cameras.
4. Stay up-to-date - The Internet can be an instant source of news and information. You’ll find the latest TV listings, weather reports and sports results from anywhere in the world. There is a huge amount of information available on the Internet on virtually every topic ranging from government law and services, medical information and research, community activities, reviews of local businesses or products, , new ideas and technical support.
5. Enjoy hobbies and interests – There are also countless websites for every hobby or interest.  Netflix has unlimited streaming of videos for just $9.95 per month. For seniors with an iPad, there is even a Netflix app. There are apps, movies and music for iPads and iPhones on iTunes. Yahoo Games has 100’s of puzzles which have been proven to have cognitive benefits. There are also senior dating sites for seniors seeking social engagement.

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There are several challenges facing communities looking to implement their own internet services for their residents. This is regardless of them managing the service with their own IT staff or selecting an outside vendor. This is best evidenced by the collegiate space, who led the trend of offering WiFi services to their residents and staff.

My background in offering WiFi and managing resident internet networks started out in 2003 in the collegiate housing space. WiFi was just beginning to take off and internet was just beginning to become a utility that was a necessity for college students. Within 2 years the number of laptops on campus outnumbered the number of desktops and WiFi became a necessity. WiFi networks that were running the latest technology, but had been built based on the user demand that was present 2 years prior could no longer keep up. Networks became saturated by users and nearly unusable. Areas that once had coverage, no longer did because of the added demand (similar to when you go to a baseball game and have problems getting good cell phone service because of the increased network demand). Even if the college’s IT department solved the issue with the WiFi, they then couldn’t support the demand on internet bandwidth. A new issue occurred with the widespread availability of broadband: subpoenas. The college received subpoenas from the MPAA (pirated movies), RIAA (pirated music), local law enforcement agencies and federal law enforcement agencies. Not all of this was caused directly by their users. Some was from nefarious passer-bys that knew they couldn’t be tracked if they just jumped on the network. Other times it was caused by a virus on the computer that then turned the computer into a file server that corrupted the network or committed illegal activities, completely unbeknownst to the computer’s owner. If the owners of the network couldn’t comply with the subpoena request or the request from their internet service provider (ISP) to stop this traffic, then their ISP could simply shut off the entire internet connection (even the business aspects of their connection) or they were opening themselves up for liability.
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Does the word “DSL” render a faint dial-up tone in your mind? In reality, cable is not necessarily faster than DSL.

DSL has gotten a bad name in the war between cable and telephone companies. The cable companies are constantly advertising that DSL is slow or associating the telephone companies’ service with an old, curmudgeon ball of cables. The telephone companies are at just as much fault by not responding to the advertising and setting the facts straight.

Let’s break it down to the science of these wires and what else is going over them. Essentially, both “cable” internet and DSL are just technology standards that digitize internet to send it over copper lines. Telephone wire and coaxial cable (simply referred to as ‘cable’) are both made out of copper. TV commercials point to telephone wires as old and slow, when cable is using wires that were most likely installed at the same time as the phone wires and cable has used essentially the same technology for the past 15 years. Cable connections also only operate on one wire while telephone operates on a pair of wires. This means digitized data has to travel up AND down this single wire, whereas telephone has a wire that it can transmit on and one it can receive on. This wouldn’t necessarily be a problem, but in addition to the internet service the cable line must also carry the TV service. As TV channel lineups continue to expand, add HDTV, and even 3DTV, it takes up more and more space on that line that the internet service has to compete with. Other than AT&T’s U-Verse, telephone lines are primarily used for just telephone and DSL internet service. Since telephone only takes up the same amount of bandwidth as a dial-up modem, this leaves the rest of the space for internet traffic.
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