The assisted living industry is very content with its state-by-state regulatory system, but a string of recent and upcoming events have escalated concerns of increased federal scrutiny that could bring unwelcome regulatory changes.
“Five years ago, I would have said we will never have oversight at a federal level,” said Maribeth Bersani, senior vice president of policy at the Assisted Living Federation during the trade group’s annual conference and expo in May. “Now, while I still think it would be a long shot, we’d be crazy if we didn’t start [considering] the handwriting on the wall.”
When members of Congress repeatedly see negative coverage of assisted living, she says, it can compel them to take action and introduce federal oversight legislation.
“We really need to be as vigilant as ever in doing grassroots advocacy, because if we don’t we really could go the way of the nursing home,” said Bersani. “Some bad stories about nursing homes is part of the reason it [came under] federal oversight.”
There have already been a couple instances of knee-jerk legislative reactions to isolated senior living incidents that received national attention.
For example, New York and California both introduced reactive legislation in the wake of the Brookdale incident in March when an independent living staffer refused CPR to an ailing resident who later passed away.
“A number of states have introduced legislation saying a company cannot tell their staff not to initiate CPR,” Bersani said during the session.
The incident also inspired an upcoming PBS Frontline story that’s scheduled to air in the middle of July, which Bersani called a “down and dirty” story on assisted living.
The segment is expected to portray the senior living industry as focusing on profits over people and includes interviews with “disgruntled employees” and families who have initiated lawsuits following some tragic events, according to Bersani.
“We expect the PBS piece to generate something on the Hill,” she says. “The story is not balanced—there are some bad things that happened, but there are also companies that have tried to make improvements to their systems or policies” to prevent those things from happening again.
During the firestorm of media coverage sparked by what happened at the Brookdale-operated independent living community, ALFA’s policy team made the rounds with news outlets educating the public about the different levels of senior living and care and providing background and information.
That won’t necessarily be enough.
“We did everything we needed to do, but it aggregates,” Bersani says. “Eventually, with enough [negative] front-page stories, [Congress] will say, ‘We need to take a look.’ It’s only a matter of time.”
As an example of when federal oversight of assisted living goes awry, Jackie Kerin, a public policy associate at ALFA, gave an overview of recent guidance from the Equal Employment Opportunity Commission (EEOC) that preempts—and clashes with—existing state regulations regarding criminal background checks for prospective employees.
The new guidance forbids employers from allowing information from criminal background checks to automatically disqualify someone from employment. Instead, all employers are required to conduct individualized assessments for each applicant allowing them to explain the nature of their offense, provide an explanation, or tell the facts and circumstances surrounding the case.
There is confusion in how to interpret the guidance in senior living settings, says Jackie Kerin, public policy associate at ALFA. State regulations for assisted living communities in many states incorporate “barrier crimes” into employee screening processes preventing applicants from obtaining a job if they’ve been convicted of certain crimes.
“We want clarification on this [new guidance],” Kerin says. “The EEOC was probably not considering our industry specifically, and didn’t see this discrepancy as far as state laws and regulations [that leaves providers] stuck between a rock and a hard place.”
ALFA is advising providers to talk with their legal counsel on how to proceed, but suggests sticking with state laws and regulations that address senior living employment standards for the time being. “Just know this is out there,” Kerin says, “and be prepared if something does develop.”
“Good, strong state regulations and laws will really prevent federal oversight,” Bersani says. “That’s the challenge to all of you: make sure your state has good regulations. That will go a long way.”
Written by Alyssa Gerace
While “going gluten free” is a nationwide trend that involves as many as 30% of American adults, according to the latest count from NPD Group, some senior living providers are shifting food services to accommodate those who suffer from Celiac Disease, an autoimmune response to gluten.
Sun City, Arizona continuing care retirement community Grandview Terrace recently spent $12,000 on bringing its kitchen and food preparation up to gluten-free certification when its administrators became aware of a prospective resident with an allergy to the protein in wheat, rye and barley. The recognition by the National Foundation for Celiac Awareness of becoming a Gluten-Free resource Education and Awareness Training (GREAT) Kitchen makes it the first in senior housing community in Arizona to fulfill the requirements.
“This was not for the diet or the fad, but to manage the medical condition,” says Bhakti Gosalia, executive director for Grandview Terrace.
The upfront investment was substantial, according to Grandview’s execs, but the community says it is already beginning to see returns on the investment through more interest in the concept.
The shift required a partial kitchen overhaul to introduce new equipment and preparation space, but training also proved costly from the standpoint of both time and expense. Training involved both kitchen staff and Grandview’s food service personnel to a color coded system and education about cross-contamination.
The upfront costs amounted to both the monetary investment and training more than a dozen staff, but the community says will pay off and already has begun to with not only the resident Grandview set out to serve with its gluten-free undertaking but other residents—and prospective residents—taking an interest as well.
A recent event in conjunction with a celiac support group sparked interest from several potential residents as to the gluten free offerings.
“Several stopped by to know more about the community, even those not part of the celiac group,” Gosalia says. “When they heard we had the event many came just for that even though they may or may not have had celiac disease.”
Written by Elizabeth Ecker
Updates introduced this week to the Older Americans Act would improve the funding potential for senior care services across the nation. Amendments to the existing legislation, reintroduced by Senator Bernie Sanders (D-Vt.), would help support initiatives toward allowing older Americans to age in their homes and their communities.
The support of Sanders, who chairs the Senate Subcommittee on Primary Health and Aging, as well as a handful of others, would strengthen the Older Americans Act—a supporter of various programs for older Americans.
“With 10,000 Americans turning 65 every day, our country’s growing population of seniors includes many who rely on these critical programs to help them stay in their own homes and communities,” Sanders said.
The new legislation amends the act, originally passed in 1965 to provide infrastructure for social services such as meal delivery, caregiver support, protection from elder abuse and job training services with an eye toward independence of seniors and supporting their ability to maintain independence in their homes.
If passed, the amendments would reauthorize core programs of the act through 2018 with a 12% increase to address a growing senior population. They would also update and address the areas of greatest need, such as those with Alzheimer’s disease; and would include added senior protections against abuse, neglect and exploitation.
Read a fact sheet on the bill.
Written by Elizabeth Ecker
Golden Girls-style living in group homes, very much like a college dorm or even a fraternity or sorority, is proving attractive to older adults and especially baby boomers looking for a sense of community.
More than 1 in every 3 boomers are unmarried, according to the Center for Family and Demographic Research. And as The Gerontological Society of America notes, a disproportionate share of these unmarried boomers are women.
A small, but growing, movement of boomer women forming group houses with their single peers, reports a National Public Radio (NPR) blog post.
One of these unique homes belongs to Bonnie Moore, a divorcee in her 60s who lives in Bowie, Maryland, a suburb of Washington, D.C.
Moore, who lives with three other women close to her age, put an add on Cragislist that read: GOLDEN GIRLS HOUSE.
The ad immediately caught the attention of Lorene Solivan, the youngest of Moore’s roommates, having just turned 60, notes NPR.
To live with a group of people one’s own age is “a big plus,” Solivan told NPR, “whether you’re 20, 40 or 60—whatever the case may be.”
Moore said she intends to expand her concept. She already has a website and says she is working on a guide to help other single boomer women setup houses like hers.
An major obstacle continues to be denial among many boomers that they might not need help getting or paying for long-term care when they age.
This obstacle is only magnified by a financial unpreparedness to hire a caregiver if they don’t have children or family nearby to care for them.
Creating a social network of people, not on the internet, but in real life is a crucial component to healthy aging, says Kathleen Kelly, who runs the Family Caregiver Alliance and the National Center on Caregiving in San Francisco.
For Moore, the decision to form her “Golden Girls House” was about more than just financial necessity.
“To come home and have someone say, ‘Hi, how was your day?’…That’s really nice sometimes,” said Moore.
Written by Jason Oliva
Severe weather events have been a major catalyst for senior housing transitions in the past few years, according to senior living referral source A Place for Mom.
Inquiries for senior living and care communities spiked anywhere from 11% to more than 90% in the two-week periods following storms Hurricane Sandy (2012), Hurricane Ike (2008), and Hurricane Katrina (2005), reveals APFM data.
After examining data from 1,700 seniors and their families that contacted A Place for Mom following major storms, the referral service noticed that inquires increased 18% after Hurricane Sandy; 11% after Hurricane Ike; and a whopping 91% after Hurricane Katrina.
“Seniors are among the hardest hit populations when disaster strikes,” said Sean Kell, CEO of A Place for Mom, in a statement. “Safety during unpredictable weather catastrophes is becoming an increasing concern, and many caregivers are seeking senior communities for a loved one that offer the security of emergency response plans along with needed amenities and services in the wake of bad storms.”
Older adults are often more vulnerable to disasters for a variety of reasons including physical or mental impairments or lack of transportation, according to MDC, a nonprofit organization that publishes research and develops programs focused on expanding opportunity, reducing poverty, and addressing structural inequity.
Around 13 million people aged 50 or older across the United States report needing help evacuating in the event of a disaster, says MDC. The vulnerability of seniors was highlighted in the wake of Hurricane Katrina, as a study released in 2008 revealed that almost half of the storm’s casualties were aged 75 or older. Similarly, for Hurricane Sandy, almost half of the more than 100 deaths attributed to the storm were 65 or older.
This past week, a tornado wreaked havoc in central Oklahoma, causing devastation in its 17-mile track that affected an estimated 33,000 people, according to Reuters, including children, seniors, and their caregivers.
In line with past incidents, APFM says it is expecting an increase in calls in the next two weeks from Oklahoma families who need help for their aging loved ones.
Written by Alyssa Gerace
Long-term care pharmacy Omnicare will not face charges that it engaged in “nationwide” Medicare fraud for off-label antipsychotics prescriptions, a federal judge recently ruled. However, the pharmacy still faces more limited False Claims Act charges over billing for antipsychotic drugs allegedly used for dementia care.
Development activity for memory care is far outpacing that of other senior living sectors, but oversupply isn’t a concern considering the concentration of projects in a few hot markets and staggering upcoming demand.
The numbers are eye-opening: More than 5 million Americans aged 65 and older are currently living with Alzheimer’s disease, a number expected to jump 40% to 7.1 million by 2025, according to the Alzheimer’s Association.
By 2050, the number of 65-and-older Americans with Alzheimer’s may nearly triple to 13.8 million. Already, one in three older Americans die with the disease or other types of dementia, according to a recent report.
In contrast, the existing memory care inventory numbers less than 75,500 in the top 100 metro areas tracked by the National Investment Center (NIC) for the Seniors Housing & Care Industry, and developers are gearing up for impending demand.
On a rolling four-quarter basis, construction starts as a percentage of overall inventory for memory care stood at 5.7% as of the first quarter of of 2013 in the top 31 markets NIC tracks, significantly more than all other sectors of senior housing and care.
Assisted living starts versus overall inventory were at 2.3% in comparison, and just 1% for independent living. The relatively high percentage for memory care overall has a lot to do with the sector’s small existing base, explains Chris McGraw, a senior research analyst at NIC.
“Freestanding memory care [in particular] does have quite a bit of construction and it’s grown very rapidly because one, they’re starting a fair number of units, and two, because there aren’t a lot of existing units,” he says.
There are just under 49,000 memory care units in the NIC MAP31 compared to nearly 193,000 assisted living units and around 265,700 independent living units, and many new starts are clustered regionally.
“The starts might seem like a lot versus inventory—5.7% is certainly very high compared to other property types—but it’s heavily concentrated within a few markets,” says McGraw. “It’s really going to only impact a handful of markets, while most markets in the country aren’t really going to face supply pressures.”
Texas has two of the MAP31′s top five markets for memory care units under construction, which McGraw partially attributed to the state’s overall accelerated construction activity thanks to a healthy economy and steady job growth.
In Dallas, 502 units are currently in development with an existing inventory of about 2,600 units for a 19.28% construction versus inventory rate. Houston’s rate is even higher, at 25.8%, with 460 units currently under construction to join an existing inventory of nearly 1,800 units.
Atlanta (10.25% construction vs. inventory), Chicago (6.41%), and Denver (17.91%) round out the top five MSAs with the most memory care activity. Across the country, several developers have multiple projects underway and many more are working on a smaller scale.
The LaSalle Group is currently developing 322 memory care units under its Autumn Leaves brand in Georgia, Illinois, Texas, and Oklahoma. Six of the Irving, Texas-based developer’s seven projects are located near hot MSAs.
New Perspective Senior Living, based in Eden Prairie, Minn., recently opened a new memory care project in Sun Prairie, Wisc. with an upcoming Glendale, Wisc. project on the boards, says CFO Ryan Novaczyk. Expansions at two other memory care communities in Mahtomedi, Minn. and Brookfield, Wisc. are also planned.
Only about 30% of MAP31 memory care units are in stand-alone communities, but with developers such as The LaSalle Group and Silverado Senior Living focusing exclusively on stand-alone communities, that trend is starting to change. In recent quarters, the construction vs. inventory rate for freestanding memory care has been outpacing that for overall memory care development.
Currently, though, a majority of memory care units are found in communities that also offer independent or assisted living or in care-continuum campuses, NIC data indicates.
The Leo Brown Group, another active senior living developer, has two Indianapolis-area projects underway with a third commencing this summer in the Columbus, Ohio area. There’s also a “robust pipeline” slated for upcoming quarters throughout the Midwest, according to vice president Mike Wagner.
Out of the 274 units either under construction or about to break ground, 79 are designated for memory care, with the rest a mix of assisted living and independent living.
“We are certainly not opposed to considering stand-alone memory care opportunities but obviously the market has to be right for us to deviate from our model of assisted living and an attached, secured memory care wing,” Wagner told SHN in an email.
The MAP31 markets with the lowest construction vs. inventory rates for memory care include Las Vegas, Miami, St. Louis, Mo., Pittsburgh, Pa., San Antonio, Texas, and San Diego, all with no units under construction by the end of the first quarter of 2013.
Written by Alyssa Gerace
At least three developers are vying for a University of California, San Francisco property that could be turned into senior housing units, according to a San Francisco Business Times report.
The 10-acre Laurel Heights campus of UCSF has received interest from at least five potential developers including Wilson Meany, MacFarlane Partners, Strada Investment Group, Tishman Speyer, TMG Partners, and SKS Investments (with Prado Group), according to the report, in what promises to be a “controversial” project development.
The university put out a request for proposals following feasibility studies last year and received the proposals in response.
“On May 17th five teams submitted proposals to take on the 10.3-acre property which consists of 447,000 square feet of building space — a 350,000-square-foot main building, a 13,000-square-foot annex, and 543 parking spaces split between surface lots and an underground garage,” the report states.
Of the five teams, three are linked to senior housing developers: The Strada Group is working with Vi by Hyatt; Wilson Meany has partnered with Mather LifeWays and TMG Partners is working with Sares Regis Group, which has developed 55+ communities across California, San Francisco Business Times reports.
“The property could continue to be used as offices or knocked down to make way for condominiums, rental apartments or senior housing, according to UCSF. A deal with a developer could be either a sale of the property or a ground lease arrangement. The zoning allows one dwelling unit per 800 square feet of land, which translates to about 550 housing units. If the project were approved as a “planned unit development” under the San Francisco planning code, the number of allowable units would jump to 700.”
UCSF had not returned a request for comment as of press time.
Written by Elizabeth Ecker
The home health care market is expected to surge to a $130 billion industry within the next five years, according to a MarketsandMarkets report.
Valued at $90.9 billion in 2012, the market for home health services is poised to grow at a compound annual rate of 7.5% each year until 2017, as it offers a cost advantage to patients by reducing their hospital spending, the report finds.
Segmented on the basis of products, services and telehealth, factors such as rising incidences of chronic diseases and increasing healthcare costs look to fuel the market’s growth in the coming years.
However, cuts in Medicare reimbursements to home health agencies and risks to the safety of home health workers are factors limiting the growth of this market, according to the study’s authors.
The United States “dominated” the home healthcare market in 2012 and is expected to maintain its position in the coming five years, notes the report.
A rising aging population, technological development for various home use, as well as increasing awareness of the importance of home care services look to contribute to the U.S. market growth.
Canada, on the other hand, it expected to experience steady growth for many of the same reasons as the U.S., including increasing awareness for home care and a rising prevalence of lifestyle diseases such as diabetes, obesity and cardiovascular diseases.
Written by Jason Oliva