The Business of Aging

Nursing Homes: How to Find a Quality Facility

General Qualities
When visiting a facility, the following are things you should ask questions about and observe.

Patient Care

Be sure to ask about prospective facilities’ staff to resident ratio for each of the following staff types:

• Registered Nurses.
• Practical Nurses.
• Licensed Vocational Nurses.
• Certified Nursing Assistants.

Inquire about how many hours a facility’s staff spends with their residents on a daily basis and if residents typically have the same nurses daily.  Also ask how often the facility’s doctors are in the facility, and how often residents receive physical check-ups and are weighed.

While visiting the facility, observe:

• The level of respect staff members give to residents when speaking to and assisting them.
• The way staff members discuss residents with other staff members.
• Whether residents seem comfortable with staff members.
• Whether residents are carefully supervised by staff members.
• How available water and other liquids are to residents.  Dehydration due to neglect is too commonly the culprit of nursing home residents’ deaths.

Staff Quality & Quantity
Find out if staff members undergo background checks and abuse prevention training; and if they screened for a history of abuse.  Ask to see the facilities most recent state survey as well as past surveys; state surveys report abuses and deficiencies in facilities, and all facilities must legally show them to you if requested.    Inquire about the home’s and administrator’s licensing status, and how often the administrator is on-site.

Quality of Life
While visiting a given facility, ask to see the cafeteria and the food; some facilities even allow visitors to try their food.  As people get older, some develop issues with eating so you want to be sure that your loved one will want to eat the food at their new home.  If your loved one attends religious services regularly, ask if the facility either offers services or transportation to services.  Find out how prospective facilities allow residents to get exercise; some facilities actually offer exercise classes.  Exercise is very important to the elderly as it helps them sustain their mental and physical capacities.  Observe the nursing homes’ environments while visiting.  Are they positive, or dreary?  Psychological health is also very important as people age.  The longer the elderly stay active physically and mentally, and happy, the longer their life will be.

Facility Cleanliness
Observe how clean the facilities you visit are, both internally and externally.  This is not an instance where you shouldn’t judge a book by its cover; how well facilities are maintained is a telling indicator of their quality.  Ask how often residents’ bedding and rooms are cleaned.

Safety
Take notice of safety precautions the facility has, such as:

• A sufficient number of wheelchair ramps.
• Adequate lighting.
• Alert systems for patients who are at risk for wandering or falling.
• Bed rails.
• Computers: Some facilities use digital medical records to prevent staff from giving residents foods they are allergic to or the wrong medications.
• Easily accessible emergency alarms.
• Safety rails.
• Security systems.

Ask the facilities you visit:

• If special service units are available.
• If the facility has isolation rooms for residents who catch a contagious illness.
• What the facility’s procedures are for emergency situations. 
• Where residents are taken in a medical emergency.
• How the facility handles residents with a history of violence or verbal aggression.

 

Beyond the Minimum Qualities
The facility you choose for your loved one should first and foremost provide good care, but it is also important that your loved one be happy at the facility; it will, after all, be their new home.  Many facilities offer activities to engage residents and promote their health, like:

• Recreational activities, e.g. picnics, fitness classes, etc.
• Social activities, e.g. holiday celebrations, coffee hours, etc.
• Arts activities, e.g. local music performances by schools, library book rentals, etc.

Amber Paley is a guest post and article writer bringing to us information to ensure your loved one lives in a quality nursing home. Amber also writes about nursing home abuse.

Elderly Services and Home Health Services: Top 25 Fastest Growing Industries

Kelly Services  reported the "Top 25 Fastest Growing Industries for 2010 to 2011".

List includes Elderly Services and Home Health Services.

Read it here.

 

Creating a Functional and Appealing Senior Space

Most senior spaces, if focused on function over form, start to resemble medical facilities characterized by neutral shades, sparse decoration, and almost no effort to disguise items that remind seniors of their health conditions. While it’s indisputable that seniors need certain pieces of furniture and layouts in their spaces, these elements don’t have to be devoid of style and attractiveness. The following tips for designing successful senior spaces are both practical and sensitive, helping you to make the most of a room or building to satisfy seniors’ needs and desires.

Getting the Functional Elements in Place

• Stairs are an obvious challenge to seniors, so keep everything they need on one level of the home. If you’re preparing to have a senior relative live in your home, you can convert an office or college son or daughter’s bedroom on the first floor into a bedroom for your senior.
• To enhance a senior’s sense of independence, lower countertops for those confined to wheelchairs so they can continue to participate in activities like cooking.
• If possible, create a “wet room” instead of a bathroom for your senior. This means eliminating all curbs and obstacles in the bathroom so that seniors with wheelchairs or other mobility aids can use the shower more easily. A drain in a gently sloping floor can help accomplish this. You might also consider placing slip prevention mats in the shower area.
• Make sure that you have traction strips on any stairs or walkways outside your house so that your senior won’t be confined to the house in bad weather.
• Low storage areas are a must. They should be well above knee level, but still within reach of someone in a wheelchair. Make sure that you have these storage areas in kitchen, bathroom, and bedroom areas.
• Install railings and grab bars. If you have stairs and your senior isn’t wheelchair-bound, some railings on both sides of your stairwell can help increase their mobility from one level to the next. Grab bars should be installed for wheelchair-bound seniors to enable them to pull themselves to a standing position. They should be located near the shower, toilet, and other areas that might warrant standing up.

Incorporating a Pleasing Aesthetic

• When painting areas designed for seniors, choose bright colors and stay away from neutrals. You might consider using colors that evoke memories, so try to picture an area that your senior enjoys and paint with those hues. Ceilings don’t have to be white and trim doesn’t have to blend in, so don’t be afraid to add some extra interest with contrast.
•  Choose colorful window treatments to help brighten up a room. You might look for fabrics that have bold patterns to keep a room’s appearance attractive.
• Try to evoke a vacation theme like a lakeside cottage or beach resort. Although this may be difficult to achieve with functional senior furniture, you can use creative lighting, bedspreads, pillows, sofa and chair coverings, and other decorative but unobtrusive items like posters and framed pictures to enhance your theme.
• Consider adding a large corkboard to your senior’s bedroom wall. Pictures of favorite memories, a calendar, and other mementoes can be placed on the board for your senior’s enjoyment.

 

Author: Alexis Bonari, a freelance writer and blog junkie. She is currently a resident blogger at  First in Education, researching areas of online education. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.

Where to Live When We Get Old. Help!

The Wall Street Journal Sunday does a great job at covering a variety of "elder" care topics week to week. This week's topic was Woes of 'Continuing Care' Centers.

The article provides not so much a critique on CCRCs (continuing care residential community) but things to consider when researching them, determining if they are the right option for you (or your loved ones) and how to go about selecting one.

The same WSJ Sunday has another article (from their sister magazine SmartMoney) titled Picking a Nursing Home which gives some good advice on finding and evaluating nursing homes. 

We have many options on where to live as we age - right? (I'm not talking geography)

Well, sort of but not really. The big four include:

1. Stay in your house/condo/apartment and as your needs increase bring in hourly help for meal preparation, assistance with activities of daily living, companionship, etc.
2. CCRCs
3. Assisted Living
4. Nursing Homes

Other options include cohabitation (dad moves in with the kids) and the really interesting (and sometimes bizarre) trend of co-operative arrangements.

While I am a huge proponent of aging in place (at home) I am aware that this option may not be for everyone - by their choice or otherwise - e.g., it is not a realistic option when your caregiving needs become too much for one or even two people to manage (the final stages of Alzheimer's).

One problem I have with the senior care marketplace is how representatives from each housing option seem to market their products as if their option (i.e., assisted living) should be the ONLY option you consider. 

Selecting a "place" to age is complex. So many factors go into it - personalities, physical and mental health needs, family dynamics, money, etc.  And people usually transition from one option to another. They start out at home, move to assisted living and then maybe to a nursing home. Making these "where to live" choices requires a lot of thought, preparation and research and unfortunately a lot of families don't put enough effort into it - or are unable to.

This is why I see a growth in truly "independent" services that educate families and individuals on the various senior housing options and guide them through the evaluation and selection. A buyer broker if you will that has no ties to any particular option nor takes placement fees or commissions from chosen options.


The closest we have to this type of service today for the masses are employee benefits like work-life or EAPs but most individuals in the country do not have access to such services. Another option is geriatric care managers (probably the best option) but they are expensive (up to $100 an hour) and not everyone can afford them. Then you have the Administration on Aging which is wonderful but like many government agencies providing support to the public it is understaffed and quality of support is inconsistent.

Maybe a solution is a type of supplemental insurance product geared toward evaluating and selecting caregiving options as we age.

I don't know but I do know there is a huge business opportunity for anyone who can figure it out.

Now if we can just pay for it once we do make the decision - but that's another topic.

Gentiva buys Odyssey. Convergence and Consolidation in the Care for Aging Americans.

Last week Gentiva Health Services (GTIV) paid $1 billion to purchase Odyssey Healthcare (ODSY).

This Investors.com article gives an excellent analysis of what this may mean for the broader senior care marketplace.  In particular, the home health care, assisted living, long-term health care, nursing home care and hospice markets.

Read the article here.

"Retrofitting" Suburbia for the Aging Population

At the 2009 Silicon Valley Boomer Venture Summit & Business Plan Competition there were a few start-ups competing in the business plan competition that intended to market products/services that would help seniors age independently in their own homes. Some of the companies proposed "retrofitting" homes to make them more senior friendly while others were focused on senior friendly technologies.

The idea of making our homes more senior friendly through both architectural design improvements and aging in place technologies is nothing new and lots of companies are investing in these areas.

But what about making our cities and towns more senior friendly?

A recent AARP survey showed 85% of individuals age 50-plus that they wish to remain in their communities for as long as possible.

A special section in the Wall Street Journal's Weekend Report (September 19th, 2009) was dedicated to "Making Suburbia More Livable" for the aging population. Or, as the intro to the story stated:

The nation's sprawling suburbs may have been a good place to grow up, but they're a tough place to grow old. 

(By the way, have you noticed the dramatic increase in stories dedicated to "aging" topics in the national media?) 

Ken Steele is the mayor of Fayetteville, Georgia and he is working to transform his community  into a "lifelong community" and suggests neighborhoods across the country need to do the same.

"Every small community has the same problem," says Mr. Steele, age 69. "We want residents to be able to age in place, to meet their needs…here, without having to move away."

The idea is to "retrofit" suburbia which involve taking a neighborhood or site within an existing town or suburb and creating a compact, walkable community—one with alternatives to single-family homes, such as condominiums or row houses. Older residents in large homes will have the option of downsizing and remaining in a community where they can access restaurants, shopping and other amenities and services on foot.

This is already underway in Lakewood, Colo. "The change is pretty dramatic," says Mike Rock, retired city manager of Lakewood who helped direct Belmar's development. "Buildings are pulled right up to the sidewalk; residential living is above the retail outlets. You don't expect to see this in a suburban setting.

"Many weekends, my wife and I don't use the car," he says. Movies, an athletic club, a coffee house and restaurants are all within walking distance. "I regularly see people who are 10 years older than me—and 30 years younger," he adds. "I like that. I like the vibrancy."

The entire Wall Street Journal article can be read here. It's a very interesting story.

Assisted Living for Individuals with Alzheimers. Do Your Homework. Manage Expectations.

My mom has advanced Alzheimer's disease (AD). In the early stages of her dementia we kept her in her home. Something I highly recommend for any senior who wants to remain at home, be safe and can still communicate this preference. Eventually, as my mom's needs increased, we hired a 'companion' from a local home care company. The one I used was Comforcare - excellent agency but it's a franchise business model so quality may vary by location.

Initially the companion visited my mom for a few hours each day (about $20 per hour and covered by most Long Term Care insurance policies) but as my mom's needs increased we increased the hours. Eventually, we hired a full-time live in from the agency for about $200 per day. Sounds like a lot and it is but quality residential care (e.g., assisted living) can be more than this in some locations.

Eventually, my mother's needs became more than what a single caregiver in the home could effectively manage. At this point we moved her to an assisted living facility. But wait, how can you place someone with AD into "assisted living" if they can't care for themselves?

As it turns out, most assisted living facilities have a dedicated floor for residents with AD. If a family can afford it, it's a better option than a nursing home (way better). If you do choose this option, in addition to the obvious questions to ask a facility , make sure the AD section is on a ground floor, residents can walk outside on their own (fenced in area of course), the staff is trained in AD, rooms have sensors to detect at-night wandering, there is plenty of stimulation, residents can get out once in a while (via a bus with a lift) and daily schedules are flexible.  One such facility that I am familiar with that meets all of these requirements is Aegis Senior Living - in particular, the Aptos, CA location. This is a very impressive facility. They "get it" when it comes to assisted living for AD.     

Now, here is where it gets interesting and why you need to do your homework when considering assisted living for people with AD.

Assisted living facilities do not typically provide one-on-one care. So if you need assistance getting dressed, going to the bathroom, getting to-and-from meals, etc. your going to have to pay extra for these services or hire an outside agency (like Comforcare) to provide "supplemental" care. And as your needs increase an assisted living facility may ask you to provide 24/7 supplemental care. So it is not uncommon to be paying close to or in excess of $100,000 a year for care in some areas.  In my experience the good assisted living facilities will be very clear about this but the not-so-good ones will be vague about it. Remember, when you take a tour of an assisted living facility the tour guide is a sales person. They get paid to place residents.

So what can a family do that can't afford this option? They typically end up spending all of the elder's money on care and then qualify for Medicaid. True, you can "spend down" or "gift" assets to other family members to qualify for medicaid faster but the laws make it very difficult to do this - and part of me understands and accepts the reasons why. 

Crazy isnt it? Yes it is. The sad truth is that families of AD patients get a double whammy because they need to spend so much more on supplemental care. And to make matters worse, the tax code and LTC insurance companies do not distinguish between elders with AD and those without so you are subject to the same daily maximums and restrictions.

I don't blame anyone for our imperfect system but as one Geriatric Care Manager recently told me "when congressional leaders have to begin caring for loved ones with AD I think the rules will be changed".

I hope you are right Nancy and I have a feeling changing this imperfect system is the final legacy the Baby Boomers will leave us with. They have the numbers and the influence to do so.

At least I hope so.

How to Manage, Operate and Market a Senior Housing Facility

Benjamin Pearce from Potomac Homes emailed me about his new book,  Senior Living Communities. It is a guide book on Operations Management for Assisted Living, Congregate, and Continuing Care retirement communities. It was just released in its second edition by Johns Hopkins University Press. 

Contemporary Gerontology describes the book as an " in-the-trenches approach to the administration and marketing of assisted living, congregate and continuing care facilities".

As the demand for senior residential communities continues to rise with the aging U.S. population, this is a great idea for a book and one that will prove useful to the many administrators and staff members who often are forced to learn by trial and error the complicated task of delivering high-quality and consistent services to elderly persons. It's also a must-read for the many facilities who have been plagued by a variety of administrative and financial difficulties.

Mr. Pearce offers a wealth of sound advice and practical solutions, discussing resident relations, operating methods, staffing ratios, department management, cost containment, sales and marketing strategies, techniques of financial analysis, budgeting, and human resources. New chapters address issues particular to dementia care and architecture, and the appendix contains a department-by-department audit of senior living operations.

Day Care - for Older American's

An article last week in the Wall Street Journal titled Finding Day Care -- For Your Parents  discusses how choices are growing for increasing numbers of Baby Boomers who have frail relatives they are reluctant to leave alone. Here are some interesting facts pulled from article:

- There are over 3,500 "adult" day-care centers in the US.
- Demand for these types of centers is growing at between 5% and 15% a year.
- The National Adult Day Services Association reports that these centers care for about 150,000 residents daily.
- By some industry estimates, adult day care serves at least 400,000 people nationally.
- The national average cost for adult day care is about $61 a day compared to about $152 per day for a home-health aid (8 hour day).
- Medicare & Medicaid Services allows a portion of Medicare home health-care benefits to go toward adult day care.   
- MetLife for the first time included adult day care as a distinct category in its annual report on costs in the long-term care industry.

The industry has also spawned franchising. Sarah Adult Day Services Inc., based in Canton, Ohio, had six centers before it began franchising its 22-year-old operation in 2004. Now it has 54 SarahCare Adult Daycare Centers either open or in some level of development in about a dozen states. Each center serves between 40 and 50 people a day, and offers day-spa services such as salons.

Look for more employers to begin offering adult care employee benefits - much like they have been doing so with child care work-life benefits. Some have already done so as evident by this release from LifeCare, a provider of work life employee benefits. 

Fewer Seniors Live in Nursing Homes: What it Means.

An article in USA Today titled Fewer seniors live in nursing homes discusses how despite the graying of the nation, the percentage of elderly living in nursing homes has declined.

The article says this trend is the result of two factors: (1) the improved health of seniors and (2) more choices of care for the elderly. However, this has much more to do with the fact that family's have more choices than it has to do with the improved health of seniors. There are a LOT more elderly people in the USA than ever before so even though the elderly population may be healthier, that alone does not explain the decrease in nursing home popularity.

For example, the article mentions that about 7.4% of Americans aged 75 and older lived in nursing homes in 2006, compared with 10.2% in 1990.

According to US Census data,  in 1990, there were approximately 13,135,000 people over the age of 75 and in 2006 this number was estimated to be 18,263,307. This means, according to the USA Today article, that in 1990 there were 1,339,770  people age 75+ in nursing homes (10.2% of 75+ population) and in 2006 there were 1,351,485 (7.4%) people - about the same number as 1990.  Yet, the 75+ population grew by over 5 million people. I don't think that many seniors are that much healthier.

So where are these people going?

The answer is most are choosing other housing options (e.g., Assisted Living) or simply staying at home - and the economical impact of this is huge, especially when you consider that by 2030, there will be over 33 million people over the age of 75. This means that even if the percentage of people age 75+ in nursing homes drops to 5% by 2030, there will still be 24% more people in nursing than today. And this still leaves a big percentage of 31 million additional people over age 75 choosing other options.

And this means strong demand for "other" housing options like Assisted Living (wonder why private equity likes this space?). And it also means strong demand for in-home care services and all the related products and services.

What related products and services? The average cost of nursing home care is more than $67,000 a year and tops $100,000 in some urban areas - and a good percentage of this cost is for related products and services the elderly person will need as a part of their care .  So if an elderly person chooses to stay at home by using a home health care company or a non-medical home care company like ComforCare,  the family or the in-home agency will need to purchase many of these products and services including such things as home safety, pharmaceuticals, medical equipment, personal healthcare, mobility, etc.

And this will be a boom for the suppliers of these products and services. And this is why services like SeniorCareMarketer will be so valuable to the suppliers to help them generate publicity, website traffic and sales leads.