Making the Commitment to Wellness with Colin Milner, CEO of ICAA

Terrence Wang (Welbi)   00:00

You're listening to Care, the Resident Experience podcast from Welbi. Every month, we chat with some of the best leaders in senior living to discover and share innovative strategies and perspectives that will impact communities for years to come. This week, we're chatting with Colin Milner, founder and CEO of the International Council on Active Aging. Colin, thank you so much for joining the show today. How are you doing?

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Colin Milner (ICAA)   00:24

Doing really well, Terry. Thanks for having me on. I'm looking forward to it.

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Terrence Wang (Welbi)   00:30

The International Council on Active Aging — that's a big title there. What drove you to start it?

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Colin Milner (ICAA)   00:37

Frustration. It's as simple as that. Over the years I've been involved in the health and wellness field, and with one of the last jobs that I had before launching the association, I was involved with an equipment manufacturer that was doing a lot of the research on strength training and aging. I would go into senior living communities and they would say, we know how to work with older adults, but we know nothing about fitness. We know nothing about wellness. And I'd go into fitness clubs and they would say, we know about fitness and we know about wellness, but we know nothing about the older adult. I waited and waited for someone to create it, and they didn't. So on my 40th birthday, I resigned my position as the president of IDEA Health & Fitness Association and launched the ICAA a few weeks later in my mind, and then I officially launched it a couple of weeks after 9/11.

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Terrence Wang (Welbi)   01:41

Wow. So you've been at this for a little while then, both in the industry and at the ICAA?

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Colin Milner (ICAA)   01:47

Just a couple of years, yeah. About 40 years in total in the industry and 20 years with the ICAA. So, yeah, you put those two together and well, heck, there you go. That's telling you my age.

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Terrence Wang (Welbi)   02:03

Hopefully it's not aging you too much. You have the technical know how of someone maybe a quarter of your age, I'm guessing. So you're doing pretty spry.

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Colin Milner (ICAA)   02:13

Yeah, I'm having a good time playing pickleball, riding and working as hard as I did and as smart as I have ever worked over the last three, four years, especially.

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Terrence Wang (Welbi)   02:26

And I guess that just shows how important active fitness is, right? Especially as you age.

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Colin Milner (ICAA)   02:32

Well, the reality is we all begin to lose our functional capacities as we get older, and one of those is our strength and our power. We lose about 50% of our strength and 75% of our power between the ages of 35 and 70. Now, you think about that, that's like me throwing someone my weight on my shoulders and walking around all day long. I would have some problems. That's why you see so many people that are struggling when they're walking. It's not because they're older. It's because they're not fit, they're not strong. And we can change that. Just simply by getting people to be stronger, especially in the legs.

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Terrence Wang (Welbi)   03:16

It's really interesting that you bring that up and you've been in this industry long enough I'm guessing to see many shifts in how we view fitness and aging. What are some of the big things that you've seen over time change?

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Colin Milner (ICAA)   03:29

Well, I think the biggest thing to me are the words “I can”. That is, when it comes to the older population, that never used to be the terminology that was used. It was you can't, you are a burden to society, you are not contributing. Today there are the Baby Boomers and their parents and Gen X that is now in the 50 plus segment. And front and center is the understanding, based on science and driven by media, that I actually can do many of the things that we once thought were just for younger people such as adventure travel, such as senior games, such as pickleball.

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Terrence Wang (Welbi)   04:14

100%. And it's really interesting that that happens. I know I've had experiences myself where 50 years old today is not 50 years old 20 years ago and even more so 60 or 70 or 80 isn't 60 or 70 or 80 like it was in maybe 2000 or 1980, correct?

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Colin Milner (ICAA)   04:35

Well, we're still 50, 60 or 70. What has changed is our capabilities. What we have understood is that we actually have the human potential to do better and all we have to do is embrace that human potential. In the past, my parents’ generation as an example or my mother's parents’ generation – that awareness really wasn't there so people weren't fulfilling that. Today we know based on science that we can live better, longer, we are stronger, we are faster, we're thinking quicker. And that is fact based on research from 30 years ago, we are healthier than we were back then. The question is do we as individuals and we as organizations that work with older adults embrace that fact or not? If you don't, you're really missing out on one of the biggest societal changes out there at this moment.

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Terrence Wang (Welbi)   05:37

When we talk about how organizations, say senior living communities, can adjust to that change, what are some of the things that you see communities doing that's creating a positive impact?

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Colin Milner (ICAA)   05:49

Well, the first thing is the word commit. Communities are actually committing to making a difference and that's where everything starts. And then from there, the kind of programs that they deliver, the cultures that they build, those all have a significant impact. We all know that if you walk into a business or a company and the culture is ripe and everybody is vibrant and engaged that you feel more at home working there than if everybody is negative and it's a downer and no one wants to be there. It’s the same with the community. If you are lifting people up, you are helping people to achieve their capabilities and they are actually fulfilling their life dreams, why wouldn't you want to live in a community like that? And why wouldn't you want to have a community like that if you don't?

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Terrence Wang (Welbi)   06:42

So it's really interesting when we talk about culture, because I've spoken with a few key individuals on this show who have talked about culture being such an important part in changing senior living towards where we want it to go. But at the same time I think a lot of the time the business objectives have nothing to do with the culture, right? So there's almost a divide between what these communities as businesses are aiming to do and what they should be aiming to do in terms of culture. Why do you think that gap is there?

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Colin Milner (ICAA)   07:16

Well I think the problem is that we have a gap because of things like public traded companies that are looking strictly at the bottom line in many instances and they will cut different elements that an organization that might be privately held would not. But the reality is that having healthy, happy residents is simply good for business. We know, based on ICAA's research that we did over a three-year period involving 5000 people in 100 different locations, that individuals that participate in wellness programs in independent living and assisted living will actually live in your community 2.7 years longer. There is a financial benefit, and there is no business that I know of in the world that can sustain itself without actually having a positive bottom line. So if we can add to that bottom line at the same time as helping people live better, longer, happier what's wrong with that?

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Terrence Wang (Welbi)   08:28

100%. It's what social enterprise is all about. And I think that's a big shift happening not just in senior living but in every business, right? Connecting those business objectives of making the most amount of profit you can and the most growth possible and linking that back to the kind of socially sustainable goals that we all want to achieve. What are the problems you see right now that still need to be tackled — we've gone a long way since the 1980s, the 2000s, but what are the problems that we still haven't gotten around to fixing yet?

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Colin Milner (ICAA)   09:01

Adaption. Adapting to the new way of thinking. Adapting to a new consumer. And when I say a new consumer, you think about all the new things that come out every single day. It used to take a long time for new things to come out. Today it's rapid, and that is also rapidly changing our expectations. But if we as an organization take a long period of time to adapt while our consumer is adapting rapidly, we're going to have a gap. And if we don't close that gap we lose business to those who are closing that gap. So I think to me, the biggest challenge and everybody has talked about it and there's a lot of pontificating over it, but you got to actually commit and move forward and not just fiddle around.

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Terrence Wang (Welbi)   09:59

For sure. And when we talk about adaptation, I know I think of adaptation a lot in terms of how technology has changed, right? Everything's more digital than it's ever been. It's cloud default now. Like I'm talking to kids these days and they don't know a world before cloud software, so that's really interesting. What are some of the gaps that you see specifically that are starting to form and ways that companies are adapting to move past?

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Colin Milner (ICAA)   10:26

Well, I think from the wellness standpoint, let's start there, the big gap is between the desire to have wellness and the desire to engage all residents and engage staff to support wellness and fund wellness, and the actual implementation. I'll give you an example. We talk about a culture. Well, in one of our recent surveys at ICAA, there was, I think it was about a 49 percentage gap between the organizations that said, yes, it's important to have everybody on board supporting a wellness culture and those who are actually effective in doing so. So I think for me, the biggest challenge is closing that gap. It's not creating new gaps. It's closing the gap that exists so that we can become truly wellness based. Instead of a lot of wellness washing that also is happening out there.

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Terrence Wang (Welbi)   11:34

For me, I remember going back into school, we talked about greenwashing. That's something that happens a lot with companies, right? Where instead of becoming sustainable, they act sustainable and they talk about sustainability, but they don't change their supply chains. And that same thing happens in senior living where, like you said, it's wellness washing. I really like that term, by the way. What does wellness washing look like versus truly wellness based communities? How can you spot the difference?

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Colin Milner (ICAA)   12:06

Well, people have great marketing, no programming. People will have great marketing and very few staff. People have great marketing — you notice the common thread there, great marketing — but they won't have a commitment towards funding wellness. That's why, when you ask me what's the first thing I would start with, that is the word commitment. If you are not committed to wellness, don't waste your time because all that's going to happen is sooner or later that's going to come back and bite you in the butt. There are people I speak with day in and day out who are given really a very small, if not insignificant budget for their wellness programs and expected to work miracles. The reality is we wouldn't do that around care. We wouldn't do that around dining. So why are we doing that around something that keeps your residents healthier longer, which impacts your bottom line, reduces your costs, reduces your recruitment, reduces your marketing costs, and actually has people staying in your community longer? It really makes absolutely no sense except for one thing, and that is the lack of understanding of what wellness can actually mean to your organization and those around you.

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Terrence Wang (Welbi)   13:29

For sure. And I think the ICAA has done a great job. We read and use your research all the time in terms of trying to quantify it and trying to help organizations quantify that. And it's one of the big gaps we do see, where even if a resident engagement division understands the impact they can have, it's tough for them to quantify that for senior management, right? It's tough for them to answer the question, well, tell me, how is this going to affect our residency rate? How is this going to make occupancy longer?

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Colin Milner (ICAA)   14:07

Well, it used to be tough. It's not that tough anymore. What it takes is an effort, an effort to actually analyze, to survey, to utilize some of the software out there to better monitor and manage numbers so that you know what is happening. If you don't know what is happening, how are you going to be able to quantify it? And unfortunately, a lot of people are still using a spreadsheet, by the way. You can still get information from a spreadsheet. So nothing wrong with that. It's just simply taking up a lot of human time when it's no longer needed. There are programs out there and, you know, I mean, we're on your show, but there are programs out there that can help individuals quantify that. They just simply need to once again commit to doing it. And then the question is, what do you do with that data? I don't know how many people I speak with that say, I want this, this, and this. And then I ask them, what are you going to do with that data? Most of them, for most of the data that they're looking at, they have absolutely no idea.

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Terrence Wang (Welbi)   15:25

That's a really good point. We collect all that data on recreation and what residents are doing. One of the problems is I just think that a lot of the senior executives, a lot of the decision makers, they're not well versed in fitness or in wellness or in how to use the data to improve programming, right? That's not their expertise, and there's nobody hiring for those types of positions, right? So what do you see as the solution here?

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Colin Milner (ICAA)   15:53

Well, I think you could say that in hospitality as well, and that is that a hospitality CEO may not be well versed in spas as an example, but you see a lot of the hospitality, whether it is a resort or whether it's a hotel, that have these beautiful spas. It's making sure you have the right people below you that understand things so that you have your support team around you if you are not that expert. One of the things that we are going to be doing actually this year, and it’s 2022, is that we will be launching very shortly in the next couple of months, an ICAA CEO Recognition Award and it is recognizing the top five wellness CEOs in the country, in North America, actually. Our goal is hopefully we will begin to recognize those individuals and also that those individuals will become benchmarks for others. They will be case studies for others, they will show best practices for others, and we will begin to see more of a groundswell happening in regards to a wellness CEO within care based communities. Which, by the way, according to our research, the market itself looks to be shifting from a care based organization with wellness to many now that are wellness based with care. We see that especially with the middle market, it is going to do nothing but grow because care is where the cost is. And if you can't afford to move into a current community, the middle market is all about savings.

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Terrence Wang (Welbi)   17:45

That's really interesting. When we talk about the middle market there, that's what we consider assisted living, right? It really is wellness based with elements of care that you can kind of pick and choose, correct?

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Colin Milner (ICAA)   17:56

No. Well, the middle market really is around people's income levels. So as an example, right now one of the challenges in senior living is that many people cannot afford the services. So by offering lesser services, not lesser quality, but fewer services, services that most of the population would use and then you have care on demand that you pay for, such as Telehealth and all of these other things that we have experienced in the middle of the pandemic, then you become more affordable for people to live in. Really what we're talking about is where most of us live today. It's just simply communities that would be for people over the age of 55, but more focused on living well through wellness as opposed to the care end of things. Because when you include the care end of things, that's where the costs and the staffing starts to ramp up significantly.

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Terrence Wang (Welbi)   19:00

100%. That is the majority of the cost right there. But you would expect some of the wellness costs to rise, right? Why does wellness provide such a big return on investment versus care, in your opinion?

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Colin Milner (ICAA)   19:16

Simple. And that is, it helps us to manage many of the chronic diseases that we have. It helps us to improve some of the acute diseases that we have and it helps us to live a better quality of life, being able to do the things we like to do, where we want to do them, with who we want to do them. By the way, 91% of Americans and Canadians look at that as the definition of healthy aging. Being able to do what you want, when you want, with who you want.

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Terrence Wang (Welbi)   19:50

That's really interesting. And then, you see so many of these communities gradually getting there and like we said, they're going through the gaps to get there. But one of the problems that I see a lot that frustrates me is that the staff aren't being provided the funding. Or if they are provided the funding, they're just barely getting enough to accomplish what they want, right? With all the benefits we talked about, and with so many of them you've already quantified, and it can be pretty easily quantified if you put in the effort yourself. Why do you think it's continually underfunded?

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Colin Milner (ICAA)   20:23

Well, we have a perception of the services that we offer, and that is cure. Blockbuster had the perception of what they offered and that was a videotape. The market changed and Blockbuster didn't, and they're no longer. The market is changing now, people are focused on how do I maintain my health longer, how do I remain healthy? What we're looking at is how do we shrink our years of ill health, expanding our health span? By doing so, we will add significantly to the bottom line or the GDP of countries. I think the number was $12.8 trillion over the next two decades if we were simply to reduce chronic health diseases by 40%. Now, that sounds like a lot, but the research has shown that we can do that simply using the interventions that we currently have, such as not smoking, not drinking, exercising, having a good BMI, eating the right kind of foods, nothing out there that is kind of crazy or whacked out. But the key is we've got to provide an environment that supports that kind of lifestyle. And if we don't, can we really expect our residents to not falter when they're not supported? Many won't, but many will.

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Terrence Wang (Welbi)   21:53

That is very important. You can see that change happening right now. What are some of the smaller tactical things that a community might be able to implement right now? Let's just say that somebody hears this and thinks, wow, maybe we've been going about this the wrong way. We do want to stop wellness washing, we do want to invest more. What do you spend the money on?

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Colin Milner (ICAA)   22:14

Well, I think you spend the money on the things that are going to have the greatest impact. So what's one of the things that will have the greatest impact? Keeping people strong. The stronger you are, the less likely it is that you're going to fall, the more solidly you're going to move up and downstairs. If you have strong legs, as an example, you are like a tree that has the trunks going in, the roots going into the ground, and that is your foundation to build from. And then you have power so that you are able to respond quickly. So really it's not very complicated. I would start on the physical end strictly because it impacts every single element and all the dimensions of wellness. But at the same time, as I'm working on the physical end I wouldn't start just doing one thing. I would look at how can I create ways for people to be purposeful, to engage within their community, in the external community, and remain purposeful, embrace their identity and focus on person-centred solutions. Really, at the end of the day, it's not very complicated. It's just doing it. I come back to that word again and I will use it over and over again because it is what is missing and that is commitment.

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Terrence Wang (Welbi)   23:40

For sure. When we talk about that person-centred, or I really like the word you use there: purposeful. In terms of helping residents themselves find purpose, again, that is a huge part of senior living right there. How can communities do a better job at that? Because I think that's one of those marketing words that's thrown around the most. But in terms of communities actually fulfilling that, the number is much, much smaller, right?

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Colin Milner (ICAA)   24:08

So I think the big problem is that we're trying to get people to find purpose. And if you were to probably interview 1000 people, I think you would have a hard time finding a lot of people who can tell you this is my purpose in life, this is the only reason I exist. Many people say my kids or my work or what have you, the standard answers. I think it's less about helping people find their purpose and more helping them to be purposeful with the things that they do. So if I'm going to go out and volunteer, I want to feel like I'm doing it and it's having a purpose. I'm being purposeful in that volunteering. If I'm going out and I'm actually teaching someone to do something, or I'm being taught, I want to have a purposeful experience, I don't want to just be there. So I think we need to just adjust our language a little bit. It's all about empowerment and inspiration versus trying to do things for everybody else.

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Terrence Wang (Welbi)   25:14

Interesting. That's really interesting, doing things with purpose instead of trying to help people find purpose, because that is kind of a lost cause sometimes. It's hard, right? You don't have a singular purpose to live for, right? There's so many different things that you want to find purpose in that you do, whether you volunteer, or your work or your family, your friends, your community. I really dig that point.

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Colin Milner (ICAA)   25:41

Yeah, I think a lot of people sit back and well, first off, I think a lot of people don't sit back. I think a lot of people actually don't sit back and think, what is my purpose? But they sit back and they think, how can I contribute? How can I get involved? How can I be engaged? How can all of those things help and make my life more purposeful? And that's really what it's about.

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Terrence Wang (Welbi)   26:08

For sure. And it's a very unique challenge for staff to navigate that, to ask the right questions, to interact with residents the right way and to provide the right type of programming for people to learn more about themselves in that way, right? What are some of the best ways you've seen that happen?

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Colin Milner (ICAA)   26:28

Just get to know the people. Instead of trying to ask these deep, meaningful questions, just get to know people. Find out what their hobbies are, what they like doing, what they enjoy doing, who they enjoy doing it with. The more you know someone, the more you know about them, the more you can offer them. One of the big challenges is when we don't know people, we don't know what they like, but we keep offering them things that they're sitting there going, well, I don't want that. And you wonder why those programs aren't filled. I think one of the problems that we also have is that we love filling calendars. The challenge is we don't need to fill the calendars jam packed. What about leaving people time to be themselves, to connect with themselves? I can tell you that I travel a lot and the greatest trips that I've had have been when I've stayed at little boutique hotels instead of places that have a jam-packed calendar for things for you to do. They have two or three things. They have great excursions and they have highly skilled individuals that take you on those excursions and they have great knowledge. And the experience is one that you walk away with going, wow. As opposed to worrying about, I'm going to go from this to that to that to that to that to make sure my day is filled. You're actually having an experience instead of a calendar.

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Terrence Wang (Welbi)   28:00

For sure, for sure. It's important to think about it that way, not because it's important to quantify — we've already talked about that in terms of quantifying what you're doing and quantifying the programming. But at a certain point, you have to remember that these aren't just numbers, right? These are people in their lives and their experiences. And that's equally, if not more important.

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Colin Milner (ICAA)   28:18

Well, it's the 80/20 rule. And that is that probably 20% of your programs have 80% of the impact and 80% of your programs have 20% of the impact. So what you want to do is find out which are the ones that are having the impact and also which are the ones that aren't, and reduce or eliminate the ones that aren't. Our research has shown over the last 14 to 15 years, that every couple of years, organizations are continuously adding more and more programming in between 69% to 79% over the last decade, as an example. Every two years it's around that. Well, that's a lot of programs being added. Yes, some programs are being eliminated, but you're not adding additional staff, you're just adding more. More isn't necessarily best. Best is more.

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Terrence Wang (Welbi)   29:15

For sure. And with added quantity without more staff, obviously, the quality starts dropping, right? And the other problem I see just personally looking at a lot of these programs is that they're creating new programs without really looking at what worked and what didn't work, right? So it's just throwing stuff out there, or you see in an article, oh these ideas are good, let me just throw these out there and see if they stick, right? Instead of looking back and having this very data driven approach of let's look at what the best 20% are, okay, let's try to do more of that and less of everything else. Then gradually, over time, you'll have this amazing experience. But it'll take the time, it'll take the effort.

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Colin Milner (ICAA)   29:55

Well, I think that CEOs would be more appreciative of greater experiences. Those experiences may require less staff time but have higher skilled individuals versus having a calendar that is jammed. And that jammed calendar also is adding to a budget that is a small budget to start with at this moment, where if you're having fewer programs, but you could add to the budget to have higher skilled individuals, maybe you would have people that have greater satisfaction.

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Terrence Wang (Welbi)   30:31

For sure. I think that's one of the ways that decision makers, ops individuals, GMs, they can really make an impact here because they're, at the end of the day, not the ones picking out the programs per se, but they are setting the direction forward in terms of how they're created or whether you're focusing on quality or quantity, right?

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Colin Milner (ICAA)   30:52

Yeah, and if you have a staff member that comes to you and says, I have a great idea that can actually help people to experience greater joy at the community, instead of going, well, what's that going to cost? Maybe a good place to start is, well, tell me how you're going to accomplish that. I'm sure a lot of people do that. But the reality is, a lot of times these programs get shut down because of that word again, a lack of commitment.

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Terrence Wang (Welbi)   31:23

It's a lot of things. It's commitment, it's budget. It's just not caring sometimes. What can management do to create that kind of open line of communication better?

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Colin Milner (ICAA)   31:33

Become better students of wellness, become better students of their residents. Those are two good places to start. If you understand your residents better and you understand how wellness can impact their lives and also how it can reduce your costs and offer something that is extremely compelling, there's a good place to start.

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Terrence Wang (Welbi)   31:56

I really love that. As we're running up against the end of our time here, is there anything else you'd like to share with listeners of the show, particularly those at that decision maker level who might not know that much about wellness, who might not care that much about wellness, but are just realizing, wow, this is something I should really be focusing on.

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Colin Milner (ICAA)   32:17

Wellness is now a buzzword around the industry. It is extremely hot. No matter what publication, what trade association, it's pretty hard to avoid it. The question is whether you are going to embrace it or whether you're going to wait while your competitors embrace it. But what I would look at is just simply ask yourself, what are we in the business of? Are we really in the business of taking care of people? Or are we in the business of helping people to live a better quality life? And if we're in that business, then let's look beyond our standard care model to be able to achieve that.

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Terrence Wang (Welbi)   32:58

I think that's the perfect way of communicating that across to people. Finally, before we say goodbye here, if people are looking to get in touch with the ICAA, whether it's for your research, for your programs, for webinars, for events, what's the best way they can do so?

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Colin Milner (ICAA)   33:14

Well they can go to our website at icaa.cc or they can send me an email at colinmilner@icaa.cc. It’'s pretty straightforward. Happy to answer any questions and there's a lot of information on there. But to have success in wellness, you need to be a student of wellness. One of the things that we can help you with is to help school you in that area.

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Terrence Wang (Welbi)   33:43

Thank you so much, Colin, for joining me on the show today. It was awesome speaking to you about wellness and hopefully this is just the first of many conversations we have about this.

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Colin Milner (ICAA)   33:54

Well, thank you, Terry, and looking forward to it.

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Terrence Wang (Welbi)   33:57

Awesome. Talk soon.

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Colin Milner (ICAA)   33:59

Bye now.