Catering to their needs

Contrary to the hype surrounding the graying of the U.S. population (see: the Social Security scare of the 2000s), the number of seniors ages 80+ is actually shrinking over the next five years due to a birthrate decline during the Great Depression.

While this fact might elicit a shrug from most marketers, to Ken Paley, it was a wake-up call.

Paley is vice president of marketing at Cincinnati-based Episcopal Retirement Homes (ERH), a not-for-profit senior services organization. Among its offerings are continuing care retirement communities (CCRCs), whose target demographic includes the 80+ cohort. Faced with a shrinking market and aware that ERH needed to develop a branding, positioning and communication strategy, Paley and his marketing team turned to research. Though as they found out, the dwindling 80+ demographic was just one of many challenges they would encounter.

ERH teamed up with Cincinnati research firm StrataMark Dynamic Solutions to conduct a research project regarding the branding and positioning for its two premier retirement communities, the Marjorie P. Lee and Deupree House. While the project was laden with geographic, generational, financial and cultural barriers, ERH and StrataMark successfully collaborated to recruit the right respondent mix; maintain participant happiness and satisfaction; and preserve data quality while gaining valuable insights from this market segment.

Lack of knowledge

What’s unique to ERH’s situation is the lack of knowledge surrounding continuing care retirement communities amongst the general public. Unlike, say, products such as automobiles or consumer packaged goods, most people aren’t familiar with the various offerings available from CCRC providers. For example, while ERH offers a continuum of services, including independent living, assisted living, nursing care and memory support, many consumers would be hard-pressed to articulate the differences among the four levels of care.

Further, the decision to go into a retirement community is one freighted with emotion, both for the prospective residents and their families. Many seniors accept growing older but worry about losing their independence - rejecting the notion that they might benefit from specialized living or care. Because of this, people who are targets for retirement communities are reluctant to learn about them. “They tend not to want to investigate what they are; what are their characteristics; how much they cost; or even all of the options available in a particular category. They tend not to do their homework until they absolutely have to, and you can imagine what that means,” says Joan Schimmel, StrataMark’s vice president, client services.

In fact, Paley says, potential independent living residents often don’t begin investigating CCRC living until an event drives them to make a choice (i.e., a fall, spousal illness or death, the senior can no longer drive, etc.) or a change in lifestyle becomes necessary (i.e., not enough energy to complete household tasks, outdoor home care becomes too much, desire for more social activity, etc.).

What’s more, many people still think of a retirement community as “the home,” and they’re thinking of a nursing home, says Paley. “A lot of folks feel that they’re going to lose their independence when they move to a CCRC and in fact it’s just the opposite because you’re not worried about waiting for the plumber or driving yourself somewhere. You actually have more independence because you get to do more of the things you want to do without having to worry about the day-to-day burdens of running your own household,” he says.

Limited target demographic

As Episcopal Retirement Homes and StrataMark found, another barrier to CCRC research is the exceptionally limited target demographic. Ninety-five percent of seniors never choose to move to a CCRC (not including those who end up in homes in the end stages of life) and most of those who choose CCRC-living are 80+ - the very same group that is dwindling over the next five years. Additionally, for reasons unbeknownst to Paley and his team, Cincinnati is the third most-saturated market in the U.S. for CCRC availability (following Chicago and Philadelphia). Thus, ERH couldn’t risk stagnating in a market flooded with CCRCs and other non-CCRC options (e.g., in-home health care agencies).

One factor in Paley’s favor was the admittedly low level of marketing and advertising sophistication in the senior care industry in Cincinnati. Most brochures look the same and follow the same formula, he says: headline; photo of the facility; 10-15 bullet points detailing the features; and contact information.

“There was clearly an opportunity to differentiate ourselves in the marketplace from an advertising standpoint. We didn’t have a whole lot of PR going on and we didn’t have much awareness in the marketplace. We didn’t have any truly distinguishing characteristics that we were promoting and our unique selling points were basically not emphasized. Our Web site, logos and identity systems were all very, very tired, and nothing looked like where these folks perceived themselves to be in the future,” says Paley.

Would be essential

In an industry dominated by the use of focus groups and secondary/demographic research, ERH decided that partnering with StrataMark to conduct primary qual-quant consumer research would be essential in reestablishing its positioning and determining what services, benefits and messages were important to prospective residents. As an added bonus, ERH felt confident that going straight to the consumer would deliver insight its competitors weren’t privy to.

However, much like the difficulties in the CCRC industry, conducting the research was riddled with challenges of its own - starting with recruiting. “There were some other really interesting barriers to getting good data, given the product,” says Schimmel.

The difficulty was finding people who fit all of the necessary criteria: not currently needing assisted living; having the financial resources to get in and stay in; being relatively healthy; and living within the marketing area. The research required 65 men and women in the right age bracket (ages 74+), in the right upper-income bracket who live in their own homes and would consider moving to a CCRC in the near future. If that wasn’t restricting enough, this very limited population became even more prescribed by geography: The majority of ERH residents come from within five miles of the community, with few coming from outside of the region.

The geographic restraints were both a blessing and a curse as StrataMark embarked on its phone recruiting. On the one hand, recruiters knew exactly where to look but ultimately had to widen the geographic scope to capture enough participants for the study. StrataMark settled on phone recruiting because it was the easiest way to contact a critical mass of people in an efficient way. Once the respondents were screened and qualified, Schimmel says most people who were invited agreed to participate. One of the ways StrataMark navigated around the stringent criteria was that they allowed for couples to participate, up to a certain point. “I don’t think we could have done it without that strategy,” says Schimmel.

Provide assistance and oversight

Ultimately, ERH came to decide on StrataMark’s Alive methodology - which involves in-person surveys administered to respondent groups who submit their answers using 10-button keypads - through a process of elimination, taking into account the significant physical barriers of the respondent age group. Vision, hearing and comprehension difficulties tend to be more prevalent in older populations. “The whole reason to do it in-person was to provide assistance and oversight. If you are not present to provide assistance, let’s say in an online environment, then either somebody can drop out of the survey or - if an online survey allows - they can skip the question or just pick an answer. That creates problems for data quality, obviously,” says Schimmel.

Online research also presented a problem because of the age of respondents. “How many people 75 years and older are on the Internet? Not very many,” says Paley. While there’s buzz surrounding the exponential increase of older generations getting online, “There’s a huge difference between a 65-year-old and an 80-year-old,” he says.

Telephone research was also discounted. It can become expensive with a very complex set of topics because interviewers frequently have to stop and help. “Moreover, the people who stop and help are professional interviewers, but they’re not necessarily people with the knowledge of the topics or the category, so that too can be very risky,” says Schimmel.

ERH also opted to pass on mail surveys. While paper surveys can relieve the anxiety around finishing quickly, it is still a self-administered technique without a professional available to provide clarification.

Senior-friendly technology

For Paley, use of the Alive methodology for ERH’s positioning project was particularly fitting for several reasons. First, ERH was in search of a qual-quant methodology with senior-friendly technology. Paley also wanted an opportunity to be involved himself and ask follow-up questions immediately. “With traditional techniques, when you get the information back you have lots more questions and have to go back out in the field or figure it out in a focus group,” he says.

During Alive sessions, participants sit either classroom-style or at long tables facing a theater-like screen and are given handheld 10-button keypads. Respondents hold the keypads and listen while a moderator goes through a PowerPoint-formatted questionnaire. Questionnaires can include various types of stimuli and ratings questions. The questions are put up on the screen one at a time, and response categories are numbered. Respondents are asked to choose the response most appropriate for them by pressing a number on the keypad. Data is captured in a bay-station database and is also available in real time for observers (usually clients) at the back of the room who watch the results come in on a monitor or laptop. At the conclusion of the session, clients can ask follow-up questions based on the quantitative data in a focus group-like forum.

Between recruitment and the live session, StrataMark and ERH collaborated to develop a questionnaire. ERH shared what it hoped to glean from the research and provided StrataMark with the CCRC details (i.e., services, amenities, pricing options, etc.) to include. StrataMark then designed the survey instrument by constructing the appropriate metrics, crafting descriptions of important category characteristics and structuring the survey questions to minimize the risk of bias across the many topics included. StrataMark also selected The Health Foundation of Greater Cincinnati as its venue for the study, as its meeting space could easily accommodate 30-35 respondents at each data collection session (alternatively, StrataMark often holds sessions in hotels or conference centers instead of traditional research facilities to host large respondent groups).

Increase the comfort level

Before the ERH session began, the Alive handheld keypads were laid out where participants would be seated and StrataMark explained how to use the devices. Following a brief explanation, the moderator walked the participants through several practice questions. The main goal was to increase the comfort level using the keypads and also ensure that all of the devices were working.

The moderator would ask a series of questions and the tech specialist at the front of the room would let the moderator know when all of the responses were in or if a certain device wasn’t functioning properly. StrataMark wanted to make sure responses were registering and gauge how long it would take to go through the questionnaire, given the group demographic.

“If you can typically get X number of questions answered in a 15-minute time frame, you have to double or maybe even triple that with an older demographic, depending on the data collection mode. There are eyesight difficulties. There are hearing difficulties. Sometimes there are comprehension difficulties,” says Schimmel.

Overall, uptake on using the equipment was fast, according to Paley. The Alive keypads were especially fitting for the age group. The buttons are extra large and the devices are battery-operated and wireless, which helped with room navigation.

“Sometimes we even swapped out the keypad whether they needed a new one or not just because it sort of seemed like the thing to do, and we did several practice rounds before we really started the research,” says Schimmel.

Dispel myths and inform respondents

After the practice rounds, the group was clued in to the topic at hand. As previously discussed, seniors tend to be reluctant in educating themselves on what CCRCs offer and how they compare to one another. A significant amount of time was spent at the beginning of the Alive session to dispel myths and inform respondents about the various services and offerings available with independent-living CCRCs. During the introductory period the moderator would stop at the end of each PowerPoint slide or question and ask if there were any questions, which were addressed by Paley. “You have to spend more time setting up the situation making sure they’re all on the same page and have the same concept of what a CCRC is,” says Paley.

Going through the questionnaire, the moderator paced the questions slowly. While the speed of the session limited how much could be accomplished in one sitting, it was an expected obstacle. StrataMark also afforded the respondents longer breaks at convenient stopping points during the research to avoid fatigue.

Used the Kano method

The research itself included ratings questions regarding different positioning, ads and taglines to give ERH marketing direction and to measure its ad and brand awareness. Additionally, feature assessment occurred using the Kano methodology, a systematic approach to identify the attributes or features a product or service must have in order to meet customer demand. “Kano helps differentiate what’s really important from what is super important so I can pinpoint what the key messages should be,” says Paley.

Two main considerations prompted StrataMark’s recommendation of Kano over other options for assessing key drivers, Schimmel says: First, brand awareness across the competitive array of retirement communities was very inconsistent, so asking respondents to rate each community on features for use in deriving importance was not possible. Also, the sample of respondents was recruited to be homogeneous in terms of their level of interest in a retirement community, so a behavioral metric such as Likelihood to Consider a Retirement Community could not be utilized properly in a traditional correlation or regression-based key driver analysis.

In addition to the Kano exercise, respondents also explicitly rated each feature. These ratings data provided something to which the Kano results could be compared. In ERH’s case, the results of both matched up with no inconsistencies. Attributes that looked like delighters in the Kano portion were also those that received the highest scores in the straight ratings exercise.

Qualitative component

The qualitative component of the research came at the very end of the Alive session. Paley formulated questions based on the data gathered during the quantitative portion and asked follow-up questions immediately for more depth and clarification. He encouraged participants one-by-one to shout out responses. He then repeated an answer for the entire group to hear and asked participants to respond on a 10-point scale how much they agreed or disagreed with the sentiment expressed in the response. “During the question portion at the end of the session, we could ask a qualitative question and instantaneously quantify it, then we knew if we had something meaningful and relevant or not,” says Paley.

Time, patience and willingness

Conducting research in a challenging industry with a challenging demographic is no small undertaking. It requires the time, patience and willingness to carefully select the right techniques and methodologies to achieve prime results.

In ERH’s case, its thoughtful approach allowed it to gather several actionable points from the research that drove ad campaigns and changed messaging and taglines, says Paley. The findings also verified prospective positioning initiatives and provided insight on introducing new services.

Even when marketers aren’t faced with problems like those encountered by ERH and StrataMark, a strong client-provider relationship is crucial in communicating what the research barriers are and how to work through them. In the end, as ERH found, true collaboration will yield invaluable advantages.