Senior Living News Wire

A private company says it is “reshaping the face of affordable housing in America” in a bold statement that follows a 2012 report by the Center for Housing Policy which weighed and measured the nation’s stock of affordable housing options for a rapidly aging population—and found it severely wanting.

GHC Housing Partners, based in Sherman Oaks, Calif., is making waves in the affordable housing arena with recent acquisitions that include two senior housing properties and a senior and family housing property, adding nearly 600 senior housing units to its existing portfolio. 

The company’s strategy is to buy up existing Section 8 housing (a government program that subsidizes rental housing for low-income households) and with its management company affiliate, PK Management LLC, offer a social component and a variety of amenities not commonly seen in affordable housing. Housing complexes owned by GHC often feature wellness and nutrition clinics, fitness centers, dog parks, gardens, job counseling, and computer labs.

“This is a new approach to affordable housing,” said Gregory Perlman, CEO of GHC Housing Partners. “We focus on our residents and provide them with the opportunity to better their lives through self-improvement programs as well as support from the non-profit Perlman Foundation.”

His outlook is similar to that of Manchester Bidwell’s CEO Bill Strickland. Dignity is essential to education, and environments drive behavior, he said in his keynote address during ALFA’s 2012 Conference and Expo.

“Don’t forget the poor people,” he reminded the audience of senior living professionals, adding that people are born into the world as assets—not liabilities. 

Regardless of how the poor are viewed, the nation faces “enormous challenges” as it prepares for its 65+ population to more than double and its 85+ population to triple, says the Center for Housing Policy in “Housing an Aging Population: Are We Prepared?“ 

A growing number of older households are facing severe housing cost burdens, shaping future demand for suitable housing and supportive services. And according to the report, demand among older renters for larger buildings with services is likely to grow, especially among the 85+ demographic. 

That makes GHC’s 2011 partnership with real estate equity manager Castle Hill Housing Partners very timely. Following the partnership, the housing company acquired 19 properties with 2,669 units in 12 states, bringing the company’s total to more than 16,000 units in 21 states and making it one of the top three owners of Section 8 housing in the U.S. and a top-10 affordable housing owner.

About half of those 16,000 units are for the elderly, and the company plans to keep making acquisitions and grow even bigger through joint ventures with other affordable housing operators. 

“We’re making offers, we’re trying to acquire housing every day, pretty much,” Perlman told SHN. “Our goal is to buy 1,500 to 2,000 units a year of Section 8 housing. This year, we’ll hit that goal—and maybe even exceed it.”

GHC’s recent senior property acquisitions include the 335-unit South Village Apartments in Trenton, N.J. and the 146-unit Hacienda Del Rio in Phoenix, Ariz., along with Essex Village, in Richmond, Va., with about 100 of its 496 units designated for senior housing.

It costs money to offer social components and amenities in Section 8 housing in addition to what’s required through the Department of Housing and Urban Development. But overall, Perlman says that “affordable housing works,” and it’s possible to get social service coordinator grants, which his company has been able to do for about 32 of its 37 coordinators.

Anything HUD doesn’t cover must be absorbed. 

“We just choose to make less profit,” Perlman says, adding that his company often partners with nonprofits and uses federal and local grants to provide services to the seniors it houses.

There’s no new Section 8 housing coming onto the market, but there is still a huge need for affordable senior housing and for more companies similar to GHC Housing Partners.

“Housing challenges are particularly severe for older adults with very low-incomes, nearly half of whom spend 50% or more of their income for housing,” writes the Center for Housing and Policy. “Federal housing subsidy programs can play an important role, but current housing subsidy programs meet only a fraction of the need.”  

Coming soon: How one nonprofit organization is utilizing government grants and programs to provide affordable assisted living.

Written by Alyssa Gerace

President Obama’s fiscal year 2013 budget recommendations to Congress included provisions cutting “bad debt” reimbursements to nursing homes in an effort to save Medicare dollars, but it might end up backfiring and costing the system more. 

Let’s say Mrs. Smith, who is dually eligible for Medicare and Medicaid, goes to the hospital after breaking her hip. After a couple days of treatment, she’s discharged into a nursing home for rehabilitation, where Medicare pays for the first 20 days of her stay.

Mrs. Smith’s recovery takes longer than 20 days, and because Medicare is no longer covering the cost of her care, she transitions to Medicaid. But the state Medicaid program doesn’t fully reimburse the nursing home the true cost of her Medicaid bed, and she’s unable the pay the balance herself, leaving the facility with what’s called “bad debt”—money it’s owed for services provided, but can’t legally collect from either the patient or Medicaid.

However, thanks to Mrs. Smith’s “dual eligible” status, the nursing home is able to partially cover the balance of her care through “bad debt” reimbursements from Medicare. Across the nation, many facilities use the Medicare program to subsidize their Medicaid residents, but new “bad debt” provisions contained in Congressional and Presidential budget proposals would cut the amount of reimbursement nursing homes can receive from Medicare for “bad debt.” 

When budget cuts take effect (pending Congressional approval), nursing homes may begin accepting fewer Medicaid patients in an effort to staunch the amount of money they lose on those beds, writes the Sarasota Herald-Tribune.

In Florida, nursing homes are facing an estimated $60.5 million cut to Medicare reimbursements, according to a study commissioned by a nursing home trade group. Other states, including Ohio, Illinois, Pennsylvania, and North Carolina, are also expecting to be heavily impacted by the “bad debt” provisions. 

“Without enough money for the system that exists, nursing home beds for Medicaid patients are quietly disappearing,” says the article. “As a result, more aging Floridians, with less family support and smaller savings than the generation before them, will find themselves stuck in the hospital with nowhere to go.”

This echoes a January New York Times article and an April MSNBC investigation about people lacking alternative care options who end up lingering in hospitals, considered “permanent” patients, at an enormous expense.

While this isn’t happening yet, there is a risk that admissions into nursing homes will be delayed as payments decrease, according to the article.

“This could mean Medicare, in trying to shift its spending of tax dollars away from nursing homes, may wind up wasting them on hospital stays,” the Herald-Tribune says, adding that hospitals generally far exceed nursing home care in cost. 

The effort to reduce Medicare outlays by cutting “bad debt” payments could actually cost the program more if it has to pay for someone’s care in a setting that’s more expensive than a nursing home, whether it’s a regular hospital, a long-term acute care hospital, or an in-patient rehabilitation facility (IRF). 

“If you have an individual who’s unable to pay and can’t make their co-pay while the facility is providing services, our members are prohibited from seeking co-payment, and it stands to reason that eventually they’ll be facing financial hardships—maybe even to the point that they can’t keep their doors open,” says Greg Crist, vice president of public affairs at nursing home trade group the American Health Care Association (AHCA). 

Facilities are already bearing the brunt of many patients’ inability to pay for their care, and they can’t stay financially viable if reimbursements keep getting cut, he adds. 

There hasn’t been any forecasted data or research as to whether the “bad debt” reimbursement cuts will result in fewer Medicaid beds, sending hospital patients in more expensive alternatives to nursing homes, so it’s impossible to say if the provision will backfire and end up costing the Medicare program more.

Nevertheless, it’s a potential concern that’s “certainly one to contemplate,” Crist says.

Especially in rural areas with disproportionately high Medicaid populations, he says, the nursing home industry’s already-slim margins (estimated at 0.75% in 2009 according to The Moran Company) can’t keep absorbing unmet co-pays without financial ramifications. 

Written by Alyssa Gerace

Senior care providers are lining up to partner with the Centers for Medicare & Medicaid Services (CMS) in its newly-announced initiative to improve dementia care in nursing homes.

LeadingAge, a trade group representing nonprofit senior care organizations, for-profit nursing home trade group the American Health Care Association (AHCA), and others involved in the nursing home industry will work with CMS toward a goal of reducing the use of antipsychotic drugs in nursing homes by 15% by the end of 2012. 

One challenge to providing appropriate dementia care is the unnecessary use of antipsychotic drugs, which happened in more than 17% of nursing home patients whose daily doses exceeded recommended levels in 2010, according to CMS data. An even greater number of dementia patients in nursing homes were administered various doses of these drugs, even if they weren’t diagnosed as psychotic. 

“A CMS nursing home resident report found that almost 40% of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis,” said CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway, M.D.  “Managing dementia without relying on medication can help improve the quality of life for these residents.  The Partnership to Improve Dementia Care will equip residents, caregivers, and providers with the best tools to make the right decision.”

CMS, along with its industry and advocacy partners, will take a three-pronged approach in achieving its goal, through:

• Enhancing training by emphasizing person-centered care, abuse prevention, and high quality care;
• Increasing transparency by making each nursing home’s antipsychotic drug use available on Nursing Home Compare starting this July;
• Introducing alternatives to antipsychotic medication, including potential options of consistent staff assignments, increased exercise or outdoor times, monitoring and managing acute and chronic pain, and planning individualized activities. 

“The long-term solution for reducing antipsychotic use in nursing homes will come from a sustained campaign that teaches caregivers how to provide real person-centered care alternatives,” said LeadingAge’s Cheryl Phillips, M.D., senior vice president for advocacy and policy. “Medications are used often as the first intervention because family members, caregivers, nurses and doctors in ALL settings lack information or training regarding alternatives.”

Providers are up to CMS’s challenge of reducing antipsychotic drug usage by 15% this year, says AHCA, as it’s a goal the trade group’s members set for itself earlier in the year. 

“Through this partnership, AHCA and skilled nursing centers across the country have a confirmed commitment, additional assistance and a common cause to better serve our residents who are living with dementia,” the group said in a statement. 

Written by Alyssa Gerace

Of the states participating in federal demonstration programs that coordinate care for dual eligibles, most are pursuing a capitated payment model, a government official said this week.

Health Care REIT Closes New $250 Million Canadian Loan with Accordion Feature

Health Care REIT, Inc. (NYSE:HCN) announced on Thursday, May 24 that it had closed on a $250 million Canadian denominated unsecured term loan (approximately $244 million in U.S. dollars). The loan is coterminous with the REIT’s $2 billion (USD) unsecured revolving credit facility, and matures July 27, 2015 with an option to extend for another year if desired.

The loan will serve as a “natural currency hedge” with respect to HCN’s recent joint venture acquisition with Canadian Chartwell Seniors Housing REIT of 42 senior housing communities in Canada. 

Based on HCN’s current credit ratings, the term loan has an initial interest rate at the Canadian DOllar banker’s acceptance rate plus 145 basis points. HCN has the option to increase the loan up to $500 million (in Canadian dollars) through an accordion feature.

J.P. Morgan Securities, LLC, Merrill Lynch, Pierce, Fenner & Smith Incorporated, and RBS Capital Markets arranged the term loan, with KeyBank National Association as the administrative agent. 

LTC Properties Amends Revolving Credit Facility, Increases Commitment to $240 Million

LTC Properties, Inc. (NYSE:LTC), a REIT that primarily invests in long-term care and other healthcare related properties, announced on Wednesday it had completed an amendment to its unsecured revolving credit facility to increase the commitment to $240 million with the option to increase commitments up to $350 million. 

The REIT’s lenders reduced the drawn pricing by 25 basis points and the undrawn pricing by 10 basis points, and also extended the facility’s maturity one additional year to May 25, 2016.

The amendment gives LTC the ability to extend the facility for one year at its discretion.

Based on LTC’s current leverage ratios, the amended facility provides for interest annually at LIBOR plus 125 basis points and an unused commitment fee of 25 basis points. As of May 30, 2012, LTC had $66 million outstanding under the facility. 

Bank of Montreal and Chicago Branch are the facility’s administrative agents, with BMO Capital Markets and KeyBanc Capital Markets as co-lead arrangers and joint book runners, Key Bank National Association as syndication agent, and Royal Bank of Canada and Wells Fargo Bank, National Association as Co-Documentation Agents. 

Cambridge Realty Closes a $13.6 Million Refinance for a Calif. Nursing Home

Cambridge Realty Capital Companies recently closed a $13.6 million HUD Lean loan to refinance Anberry Rehabilitation Hospital, a skilled nursing care facility located in Atwater, Calif. 

The 33-year, fully-amortized loan was arranged for the property’s owner using HUD’s Section 232/223(f) funding program. Cambridge Realty Capital Ltd. of Ill. underwrote the loan; the interest rate was not disclosed. 

Hymie Barber, Cambridge’s national originations manager, coordinated the transaction. 

Senior lifestyle services provider LCS recently entered into a joint venture agreement with Mainstreet Property Group, LLC, based in Cicero, Ind. to own and operate the first of several skilled nursing, short-term rehabilitation, and assisted living communities.

Mainstreet will act as the real estate owner and developer, and already has 13 similar communities currently in operation. The first joint venture community, Wabash Health and Wellness Suites in Wabash, Ind., is currently under development with a projected opening date of January 2013.

The 67,000-square-foot project sits on more than 30 acres of land and will feature 70 skilled nursing and short-term rehabilitation suites with 30 assisted living apartments. Construction is expected to cost about $15 million. The community is also partnering with Live Well in Wabash for a satellite senior center location in Wabash County.

Three other Indiana sites will be part of the joint venture: Westfield, Avon, and Crawfordsville. The communities will be managed by Life Care Services, an LCS Company out of its Greenwood, Indiana office. 

“LCS provides long-term care and rehabilitation services in the majority of communities we manage,” said Rick Exline, Executive Vice President/Director of Operations Management of LCS, in a statement. “This prototype allows us to provide these services in smaller cities that have not had access to assisted living and rehabilitation in the past.”

Shiel Sexton, based in Indianapolis, Ind., is the general contractor in Wabash, while Meyer Najem Construction of Fishers, Ind. is the general contract for the Westfield, Avon, and Crawfordsville sites. 

Written by Alyssa Gerace

The 2011-2012 flu season was more mild and peaked later than in previous years, the Centers for Disease Control & Prevention reports.

The Eden Alternative, a culture-change long-term care program, has announced the acquisition of Lifespan Network’s Wellspring Program.

Assisted living can function as an “obvious solution” for preventing hospital readmissions thanks to technology and care partnerships, but first the industry must develop a model to measure outcomes and educate the care continuum of its abilities, said a panel of senior living executives at the recent ALFA 2012 Community event. 

Educating others on the viability of assisted living as a post-acute option is key.

“We have to educate hospitals on how we can be an option for them,” said panelist Judd Harper, COO of The Arbor Company. Education is especially relevant as the Accountable Care Organization (ACO) trend—and managed care in general—grows in popularity, the panel agreed. 

“People say they don’t know if ACOs are going to happen, [but] that train has left the station. It’s happening,” said Stephanie Handelson, president and COO of New England-based Benchmark Senior Living, during the session. 

Tracking data to measure outcomes is a key component in building a desirable partner profile for hospitals.

Almost all of Belmont Village’s senior living communities offer in-house access to rehabilitation services, said its president, Patricia Will, but it’s more than just providing space for post-acute care services.

“We need to attain and maintain a model on how to measure outcomes,” she said during the session. 

ACOs essentially have a “negative” measurement, she continued: Don’t send residents back to the hospital.

“We are an obvious solution to that,” she said. “But how we establish the metrics around that is a challenge.”

Typically, senior care providers track data and outcomes in accordance with Medicare requirements to receive reimbursements. But because the assisted living industry doesn’t participate in the Medicare program, by and large, tracking outcomes isn’t generally part of the model.

“We will have to figure out how to look at resident outcomes in a business that doesn’t measure those things, because ACOs will have to know that,” Will said.

Technology plays an integral role in allowing assisted living providers to partner with other post-acute care providers. With the evolution of wireless technology, healthcare providers are trying to figure out its role in their communities, noted Paul Donaldson AIA, LEED AP, a principal at international design firm Perkins+Will. 

“We’re constantly battling with our clients trying to make decisions about how they want to track things,” he said, adding that his firm is seeing “a lot more crossover” from its healthcare clients who are becoming more accountable for their discharged residents. 

As a business, the assisted living industry is trying to grow into that accountability aspect and tap into the world of care, Donaldson said. 

Written by Alyssa Gerace

A multi-billion dollar federal initiative to move low-income elderly and disabled people from long-term care facilities into the community has fallen far short of its goals, as many states have struggled to cobble together housing and other services.

Launched in 2007 during the Bush administration, the states initially projected placing 35,380 Medicaid recipients in the first five years. As of March 31 at least 22,500 had made the transition, about 36 percent below the states’ target.

The numbers vary sharply by state. Some, such as Texas and Ohio, have helped thousands find homes in their communities. Others, including North Carolina, Missouri and Kentucky, have moved fewer than 500 each.

In California, only 827 people have made the jump since 2008, although the state was awarded $41 million during that time. “We’re not doing a good job of it here,” said Deborah Doctor, legislative advocate for Disability Rights California. “It’s pathetic.”

Some states have found it especially difficult to move the elderly. While the vast majority of eligible people are seniors, only about one-third of the program’s participants are age 65 or over, according to Mathematica Policy Research, a Princeton, N.J.-based firm hired by the government to evaluate the project. Most of the other participants are adults under 65 with physical disabilities living in nursing homes and developmentally disabled people living in institutions.

While advocates strongly support the program and its goals, many say they are disappointed with what they see as its glacial pace, given the $4 billion Congress has authorized and the fact that about 900,000 people living in institutions meet the eligibility requirements.

“It’s very frustrating to us,” said Kate Ricks, who heads Voices for Quality Care, a multi-state long-term care advocacy group based in Maryland. “At the rate they’re getting people out, everyone who is eligible will be dead.”

Officials from the federal Centers for Medicare & Medicaid Services, which administers the program, acknowledge that it was tough for many states to get rolling; some states didn’t start until 2008. But they say the pace has picked up – placements have doubled in the last few years.

“We’ve transitioned individuals from nursing homes who have been over 90 years old and have been able to serve them extremely well in the community,” said Ron Hendler, CMS’ technical director for the program. “They have been very complicated transitions, but we’ve been able to do them – and very successfully.”

States Receive Extra Funds

To participate in the program, a person must express interest and be enrolled in Medicaid, the state-federal program for the poor and disabled. Transition counselors help coordinate their move into houses, apartments or group homes of four or fewer residents – or, in some cases, assisted living facilities.

The program, called Money Follows the Person, offers states extra Medicaid funding to pay for the participant’s home and community-based services over 12 months, as well as furniture, security deposits and renovations to make housing accessible to the handicapped.

The program was slow to get off the ground for a number of reasons. Some states had a shortage of direct care workers. Some faced bureaucratic obstacles — for example, problems meeting federal reporting requirements or setting up quality monitoring systems. Some ran into delays in negotiating contracts with transition specialists or case management contractors, according to a July 2011 report by the National Association of States United for Aging and Disabilities.

Mathematica found that some of the barriers to moving the elderly included dealing with their intensive medical needs, lack of community-based services and difficulty arranging support from family members.

Another challenge in many states is finding affordable, accessible housing for participants. Elderly nursing home residents may not have a house or apartment to return to. Long waiting lists for subsidized housing vouchers may delay transitions for physically disabled adults.

Wayne Cook, of San Leandro, Calif., struggled to find a place to live.

Cook, 56, suffers from polymyositis, an inflammatory disease that attacks the muscles. He was living in a nursing home when he signed up for the program.

His transition counselor gave him a list of apartments, but many had been rented months earlier. “I just started getting on the bus and looking for places on my own,” said Cook, who uses a wheelchair.

Cook said it took him more than six months to find a landlord who would accept his Section 8 housing voucher. He finally moved into a one-bedroom apartment that wasn’t handicap-accessible but was on the first floor.

“Man, it’s kind of hard to describe what it was like to go back to an apartment,” he said. “I had come a long way from people telling me I was going to be bedridden for the rest of my life. I can’t put it in words what it felt like to get my own door key again.”

Cook said the hardest part for him has been dealing with tasks such as paying bills and grocery shopping.

Transitions Present Challenges

That’s a common concern for people transitioning out, said Robyn Grant, outreach director for the National Consumer Voice for Quality Long-Term Care, an advocacy group.

Grant has interviewed more than a dozen Money Follows the Person participants who’ve left nursing homes. While they praised the program, they’ve stressed the need for more life-skills training in areas such as personal hygiene, menu planning and hiring caretakers.

“Nursing home life is very regimented,” Grant said. “You go from everything being decided for you to it being wide open. A number of people said getting used to that was a big adjustment.”

Some participants end up returning to nursing homes and institutions. The states routinely send CMS data about how many people died or have been reinstitutionalized during their time in the program. CMS officials would not release those numbers to Kaiser Health News.

A 2011 Mathematica report found that out of 4,746 participants studied, about 14 percent of seniors and about 10 percent of people with physical disabilities returned to an institution within the year. Eleven percent of seniors died during that time, as did six percent of people with physical disabilities.

For participants who remain in the program, once the year ends, the states are expected to use their Medicaid dollars to continue paying for the participant’s day-to-day services, such as home health, case management and personal care.

States are also required to take some of the Medicaid funds they’ve gotten for Money Follows the Person and reinvest them in long-term care services, shifting spending from institutional to home and community-based care. The idea is to help keep people out of nursing homes and institutions from the start.

Congress Repeatedly Invested In The Program

In 2005, Congress authorized $1.75 billion to fund the original five-year project in 30 states and the District of Columbia. States started receiving their awards in 2007, and by the end of 2008, most had launched their programs. In 2010, Congress authorized another $2.25 billion for the program under the Affordable Care Act and extended it through September 2016. Thirteen more states won grants last year, bringing the total to 44.

So far, the federal government has paid or committed to pay $1.1 billion to the states, according to CMS officials.

Each state decides which target population it wants to transition: the elderly, adults with physical disabilities, the developmentally disabled or the mentally ill. Some states choose one or two groups, others include all of them. Some have comprehensive community care networks already in place. Others don’t, and must spend a big chunk of grant money getting their programs running.

“The states that started from almost zero have had to really struggle,” said Barbara Edwards, director of CMS’ Disabled and Elderly Health Programs. “The states need the dollars to make the investment in the infrastructure, but you don’t get the dollars till you move people. But you can’t move people without the infrastructure. There was a chicken and egg problem.”

Even now, a handful of states are responsible for the bulk of placements. The biggest by far is Texas, which was awarded $123 million for the first five years of the program and by the end of 2011 had moved out 5,298 people.

Texas officials say their state had already been operating its own version of Money Follows the Person starting in 2001. “We had earlier experience and looked for the barriers and how to address them,” said Marc Gold, manager of Texas’ Promoting Independence program. “I think other states having problems probably didn’t have an infrastructure at all.”

Some states are struggling. Joel Weeden, who runs the program at the California Department of Health Care Services, blames much of the problem there on the logistical headache his agency faces because it contracts with a network of two dozen local agencies responsible for transitioning people.

“We did not have an existing statewide system in place for coordinating home and community based services,” Weeden said. “California has a fragmented system.”

In a few states, Money Follows the Person never even got off the ground – or ended abruptly.

In Florida, lawmakers last year failed to give state officials the authority to use their $35.7 million grant award because the funding was authorized under the Affordable Care Act, which the state is challenging in federal court.

And in Oregon, officials suspended their program last October after a state investigation cited irregularities and money spent improperly. While the probe found no evidence of fraud or collusion, it concluded that the director had agreed to use grant funds to pay providers for construction and remodeling of housing that wasn’t allowed. The director resigned and two other state officials left their jobs.

“The issue here was a lack of oversight and lack of adequate controls,” said Jim Scherzinger, the Oregon Department of Human Services’ chief operating officer.

In the four years the program operated, the state spent $16 million in federal funds on client services and $5 million on administrative costs, according to Scherzinger. Only 306 people transitioned out. Scherzinger said the program was “of marginal benefit” because his state already was a leader in diverting people from nursing homes into community settings.

Oregon State Sen. Jackie Winters, who serves on the Ways and Means committee, said the program was “wracked with problems.”

“They grabbed the money without real planning,” said Winters, a Republican from Salem. “The federal government holds out the carrot for states to receive revenues. States have been very, very strapped. They’re anxious for the dollars that come down…It’s just like a kid going into a candy store.”

One area that Congress didn’t address when it authorized Money Follows the Person was whether it would save money.

In a February review, CMS contractor Mathematica found that the cost of community-based long-term care services is 34 percent lower than what Medicaid programs typically pay for nursing home care. But the study was inconclusive about whether Money Follows the Person is saving taxpayer money because it did not assess the cost of medical care for people living in the community.

“We have not made that determination. We feel it’s a little too early,” said Mathematica project director Carol Irvin. “Don’t construe that it saves money to have someone in the community.”

Other than the Mathematica reports, no federal agency has evaluated the program. The Government Accountability Office is expected to release a report in June that examines the states’ plans for providing home and community services and how they are implementing different types of options, said Katherine Iritani, a GAO director for health issues. The review will include Money Follows the Person, but won’t be assessing its cost effectiveness or quality.

Whether the program saves money or not, both advocates and government officials agree that it’s the right policy direction because it gives people choice in how and where they live their lives.

But even boosters say there need to be improvements.

Federal officials want states to continue modernizing their data and tracking systems. Advocates want improved monitoring and oversight.

“One of the things we’re most concerned about is that people are actually getting the quality services and follow-up,” said Lori Smetanka, a director at The Consumer Voice. “The states have to submit assurances about how they’re going to monitor the quality, but we aren’t yet satisfied about how they’re doing that.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Some people just aren’t willing to move into a designated senior living community and would rather stay in their own homes and communities with the help of services and their neighbors—a desire supported by the ‘Village’ concept that’s spreading across the nation, the Boston Globe reports. 

“This is a common sense movement that comes from elderly organizers themselves,’’ said Judy Willett, the former director of Beacon Hill Village and the new national director of Village to Village, which is based in Newton. “Ultimately, it’s elderly volunteers who organize each village, and every [group] has roughly the same values and same core goal of helping people stay in their homes.’’

Though some groups allow people 50 and over to join their village, most organizations set the age limit at 60 and up.

[One village's] offerings include a “one call’’ phone service where staff help members with requests that can range from how to hire a snow plow operator to dealing with health insurance issues. Dues also cover grocery deliveries, provided by a transportation company, and a free driving service for members – handled by volunteers – to get to medical appointments or the pharmacy.

For an additional fee, members can access a screened list of home service providers, including plumbers, electricians, handymen, physical therapists, home health care assistants, tailors, gardeners, and others. After interviewing each participating vendor, Cambridge At Home secures 10 to 15 percent price discounts from them for its members.

The state director of Massachusetts’s AARP chapter called the Village movement a “model of how to care for the elderly who want to stay in their homes.” 

Read the full Boston Globe article.

Written by Alyssa Gerace

Federal officials unveiled a medication reduction initiative with an ambitious goal: trimming antipsychotic drug use among residents by 15% this year. The Centers for Medicare & Medicaid Services’ Partnership to Improve Dementia Care follows up on industry groups, consumer advocates and legislators’ increased scrutiny on antipsychotics.

Senior Housing Properties Trust (NYSE:SNH) announced on Wednesday that it had entered into agreements for early terminations of leases for 10 senior living communities currently managed by Sunrise Senior Living (NYSE:SRZ). The senior housing REIT plans to lease the communities to its taxable REIT subsidiaries with Five Star Quality Care, Inc. (NYSE:FVE) as the new manager.

At the end of the fourth quarter, Sunrise told SNH it wouldn’t be renewing the 10 leases once the current terms ended on Dec. 31, 2013. Renewing the leases would have required approval from Marriott International, Inc. (NYSE:MAR), the guarantor of Sunrise’s lease obligations; Wednesday’s agreement accelerates the lease terminations and transfers operations from Sunrise to SNH’s taxable REIT subsidiaries (TRSs). The senior housing REIT will also purchase the inventory and certain improvements owned by Sunrise at these communities for $1 million. 

“Because of the expected termination of Sunrise’s leases at year end 2013, SNH believes it is important for the community residents and for SNH that these operations be transferred to a manager with a longer term outlook as soon as possible,” said David Hegarty, President of SNH, in a statement. 

While he said that Sunrise has appeared to have made progress toward improving its financial condition since “accounting irregularities” were disclosed a few years ago, Hegarty pointed out that Sunrise remains in default of certain debts.

“In these circumstances and in the absence of continuing guarantees of Sunrise’s obligations from Marriott, SNH determined that it would be best for SNH if these operations were transferred to its TRSs and managed by a financially stable, high quality operator like Five Star,” he said. 

In 2011, the 10 communities a combined average occupancy of approximately 87%, with combined gross revenues of about $115.6 million. The revenue came mostly from private-pay residents, rather than from Medicare or Medicaid. 

Sunrise has historically paid minimum rents of $13.5 million per year to SNH for these communities, plus percentage rents of approximately $2.8 million based on revenue increases at the communities. Net cash flow from operations in 2011 was approximately 1.5x the minimum rents due to the REIT. 

The communities are located in Arizona, California, Florida, Illinois, Texas, and Virginia, for a total of nearly 2,500 units.

The new management contract between SNH and Five Star will be similar to previous contracts for other communities Five Star manages for SNH. The REIT landlord will pool all its contracts with Five Star, including those for the Vi Classic Residences, so it can determine incentive fees due to the operator.

Sunrise will continue to lease four SNH-owned communities with 1,619 living units under leases running through Dec. 31, 2018, with obligations that will continue to be guaranteed by Marriott.

Written by Alyssa Gerace

Late Tuesday afternoon, troubled senior living operator Assisted Living Concepts, Inc. (NYSE:ALC) named Lt. General USAF (Ret.) Charles Roadman II, M.D., as its interim president and CEO. 

Assisted Living Concepts’ board fired former president and CEO Laurie Bebo, reports Bloomberg Businesweek, which cited an unnamed spokesperson as saying the board “thought it was time for a leadership change and no one issue prompted the move.” 

“Dr. Roadman’s significant leadership experience, tremendous knowledge of the healthcare industry and strong commitment to excellence have been demonstrated time and again throughout his impressive career. We are pleased that he has agreed to accept the interim position during this transition period,” said David Hennigar, chairman of the ALC Board of Directors, in a statement. “We are confident in Dr. Roadman’s considerable abilities and leadership skills to concentrate on and directly address certain matters facing ALC while the company focuses on providing the quality of care that meets the expectations of our residents and the ALC Board.”

The “matters” Hennigar is referring to may include the lawsuit Ventas filed against the company in late April, which alleges that ALC is in violation with its lease with Ventas Realty.

Several ALC-operated communities are facing state regulatory actions for violating certain regulations. Three communities located in Georgia and Alabama have received notices of license or permit revocation hearings for deficiencies deemed detrimental to residents, or for not being in compliance with state regulations. 

Shortly after the lawsuit was filed, ALC announced it would delay its first quarter earnings release and conference call.

“I recognize that we have areas that need attention, and those matters are my top priority,” said Dr. Roadman. “We will take the necessary steps to enhance care and the quality of our services to meet the expectations of the Board and our residents.”

Written by Alyssa Gerace

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