Senior Living News Wire

On Nov. 13, 2012, LeadingAge is supporting National Memory Screening Day, an annual initiative of the Alzheimer’s Foundation of America (AFA) in which qualified healthcare professionals at local sites nationwide provide free, confidential memory screenings and educational materials to the public. 

Establishing partnerships between assisted living and other post-acute care providers—particularly rehabilitative services—is essential going forward in the senior living industry, a panel of senior care executives told attendees of ALFA Community 2012 session in Dallas on Wednesday.

While there are many different components of the post-acute care continuum, the relationship between rehabilitation and assisted living is crucial, especially in light of healthcare reform, they said.

Accountable care organizations and the concept of managed care will have a huge impact as hospitals begin to launch efforts toward avoiding costly readmission penalties by discharging patients to trusted partners with proven outcomes. Having an on-site rehabilitation clinic in an assisted living community can help improve not just a senior living provider’s partnership profile, but can also be useful in marketing to prospective residents.

For some assisted living communities, this can be done by leasing space to a rehabilitation provider. That provider can offer physical therapy, occupational therapy, and speech therapy about five times a week, and it’s very convenient for residents who can visit the clinic right in their community rather than having to go off-site.

Outsourcing to third-party providers can be wise for senior living providers as it allows them to coordinate care for their residents while remaining focused on their own strengths (rather than becoming licensed to provide rehabilitation services).

“To master what rehab does is a totally different skill set [than providing assisted living services]. From my perspective, we’re going to outsource with quality companies,” said Jon DeLuca, president and CEO of Chicago, Ill.-based Senior Lifestyle Corp. His company uses Genesis Rehabilitation Services in most of its communities for what DeLuca terms a “win-win” situation.

Being able to tout a state-of-the-art rehabilitation center can help woo residents, and Senior Lifestyle Corp. is working with Genesis to make their gyms more visible, rather than treating them as an afterthought and placing them in out-of-the-way locations.

“Instead of an institutional look, it’s a hip place,” DeLuca said. “You’re doing something great for the resident. If that’s going on when a potential resident is touring, it’s powerful; you can talk to them about all the things you can do [at your community].”

A good partnership with another service provider can help.

“We want to help you get move-ins by saying, ‘Here are the services you can receive on-site. You can stay at your home and get these services,’” said Dan Hirschield, President of Genesis Rehabilitation Services.

Using data to track outcomes

Tracking residents’ data is extremely important, especially when looking for care continuum partnerships. Despite the fact that most assisted living providers don’t benefit from Medicare reimbursements, the assisted living population “is the Medicare population,” Handelson said—especially for those who partner with rehab services.

Assisted living communities send a lot of people to emergency rooms, she said. That’s partly because of regulation and partly because of staffing, but there needs to be a lot of emphasis on preventing episodic events.

In Genesis Rehabilitation Services’ experience, most people are concerned with falls—a commonly occurring incident that can send residents to the ER.

“Typically, independent living and assisted living providers don’t have those statistics [on falls]; in the past, they haven’t had to track that, so it’s hard to get a baseline,” explained Hirschfield.

After pulling its data, New England-based Benchmark Senior Living realized that about 75% of its residents were using some kind of walking device, according to its president and COO Stephanie Handelson. At Benchmark, it’s important to focus on preventive care.

“It’s the right thing to do to preserve their current health, or maintain their health so they don’t decline,” she said.

About three to four months ago, 10 Benchmark communities began providing rehabilitation services onsite. Of those, nine have had “significant progress and great outcomes,” said Handelson.

Even if a community doesn’t have to worry about being penalized for readmissions or having Medicare reimbursements get cut, it needs to prove to those who do have “skin in the game” that it will be a good partner, she continued.

The senior living industry is in the midst of a “perfect” storm—global aging, healthcare reform requirements, threatened entitlement programs, and substantially lowered home values—that requires a culture of innovation in order to thrive, writes Michele Holleran, the founder of research firm Holleran and consultancy firm DeArment Consulting, in a recent white paper.

That storm isn’t going away, says Holleran, so the industry needs to use technology—and more—to weather it and survive.

There are plenty of senior care technologies that are either being developed or have already been implemented in some senior care settings, and Holleran names the Intel-GE Care Innovations collaboration, among others, as belonging to the technology sectors that has “certainly done its part to raise the bar on senior living innovations.”

But innovation in senior living, says the white paper, goes well beyond technology.

The lesson for would-be innovators is that they do not have to invent brand new ideas, but rather borrow ideas from other fields. To do this successfully, aging services providers are required to carry out 5 key skills outlined in the Harvard Business Review article, “The Innovator’s DNA.”

These 5 skills include questioning, observing, experimenting, networking and associating. Embedding these skills into the fabric of aging services provider organizations is step one in creating a culture of innovation.

Holleran goes on run through those five skills, giving examples of how those in the senior living industry have applied them and made their organizations stronger and better prepared for the future.

This includes Evangelical Homes of Michigan, one of about a dozen senior living providers who have implemented “CCRCs without walls” programs to provide services to those living in their community who didn’t want to leave their homes.

Other programs and models that have emerged include Programs of All-Inclusive Care for the Elderly (PACE), Small House models, Naturally Occurring Retirement Communities, Villages, and more technology- and policy-minded developments like implementing electronic health records, forming accountable care organizations (ACOs), and making breakthroughs on cures for memory impairment diseases.

“The challenges of the future will be the creation of affordable alternatives for those who have not put together the resources required for comfortable retirements or will not be covered by traditional entitlement programs if funds run out,” says Holleran after concluding that ”Innovating is not for the faint of heart. It takes a willingness to try something new, and risk failure.”

Read the full white paper.

Written by Alyssa Gerace

A recent NBC News investigation looked into the costly world of “permanent” hospital patients: when hospitals are forced to keep patients for months—even years—because the patients have nowhere else to go. All of this happens at enormous costs to hospitals, costs that usually can’t be recouped because the patients have no way of paying for their care.

In many cases, the patient could be adequately cared for in a skilled nursing facility setting, rather than in an acute-care (and extremely expensive) hospital setting, found the investigation, covered in an MSNBC Rock Center article.

But because of current healthcare policies and guidelines, “under federal law, hospitals must treat any patient who needs emergency medical attention even if they have no way to pay. Nursing and rehab facilities are not required by law to do so.”

And with hospitals unable to discharge patients unless they have a plan for post-acute care, many facilities get “stuck” with these permanent patients who have “large medical bills and no way to pay.”

“It would be cheaper to take these patients and send them to the Ritz Carlton,” said Harvard University School of Public Health Professor Ashish Jha in the MSNBC article. “They could get room service all day, and that would be cheaper.”

Tens of thousands of these patients are stuck in hospitals with nowhere to go for long-term care or rehabilitative services, Jha estimates, and the NBC News investigation found officials at “dozens” of hospitals across the country confirming they had long-term patients who didn’t need to be in an acute-care setting.

If so many of these people could be cared for in a skilled nursing setting, is it worthwhile for hospitals to introduce some sort of skilled nursing division into their facility? As of 2010, just 6% of skilled nursing facilities were hospital-based (as opposed to being freestanding), according to the Medicare Payment Advisory Committee’s 2012 report to Congress.

But while it might be cost-effective for these particular patients to be in a less-acute setting, these sorts of incidents don’t occur to the point where it’s logical for hospitals to add SNF beds, according to Greg Crist, vice president of public affairs at the American Health Care Association, a nursing home industry trade group.

“It’s more the exception than the rule,” he found after getting input from a few providers. “Hospitals can’t necessarily do any sort of economic forecasting to the point where it would be viable.”

While some hospitals have looked into adding a skilled nursing center, Crist says the high number of regulations surrounding the industry have prompted many to just stay in the acute care sector.

Back in January, The New York Times ran a similar piece about illegal immigrants lingering in hospitals at a high cost because they had nowhere to go.

Read the full MSNBC Rock Center article, which talks about a more than 2 year, $1.4 million stay in an hospital by an undocumented immigrant who, according to the hospital’s chief medical officer, belonged in a skilled nursing facility but couldn’t go because she had no way of paying.

Written by Alyssa Gerace

Construction: Planned

INVENCO Seniors Housing to Build ALF in Fla. for Veterans

INVENCO Seniors Housing, LLC, will pioneer an operating plan to help U.S. veterans find affordable housing solutions for a Viera, Fla.-located assisted living center meant to affordably house U.S. veterans.

Viera Manor Assisted Living Facility will give veterans priority admission for 80% of available units, in addition to a 10% discount off of estimated market rental rates. The facility will have 86 units and 102 licensed beds, and resident veterans will have access to the Veterans Association Clinic, located adjacent to the project site.

Love Funding provided $8.56 million in construction and permanent financing loans, led by senior director Laura Saull-Smith.

“This innovative VA program is designed to give veterans access to high-quality, affordable housing that meets all of their needs,” said John Goode, a managing member at INVENCO. “We are proud the VA chose us to provide that level of service to the men and women who have provided so much for our country. The Love Funding team led by Laura guided the financing to an optimal outcome. The tenacity and commitment they demonstrated in providing all the services this one-of-a-kind financing required was truly remarkable.”

NRP Group Planning Affordable Senior Housing Complex in Ohio With $1.2 Million in Tax Credits

Developer NRP Group is a planning an affordable senior housing complex in Kent, Ohio, after getting $1.2 million in tax credits from the Ohio Housing Finance Agency, reports Ohio.com. The city will also contribute $250,000 form its Community Housing Improvement Program.

The development project is being called Four Seasons at Golden Pond and will help replace Silver Oaks Place, a retirement community that was sold last year and converted into student housing, forcing its elderly residents to relocated with only a couple months’ notice, the article notes.

Kent’s Planning Commission has already approved the preliminary site plan for Four Seasons, and NRP Group is in ongoing discussions on how to finance the project.

Lutheran Social Ministries Plans Affordable Senior Housing Project in NJ

Nonprofit housing development organization Lutheran Social Ministries recently got approval for final site plans for an affordable senior housing project located in Cinnaminson, New Jersey, reports the local Patch.com.

Plans including razing most of an old building (the Cinnaminson Home) but leaving a historic brick section intact, then building 55 units of affordable senior housing; Lutheran Social Ministries is waiting for final approvals from the county.

A federal district judge has invalidated a union elections rule this week on the grounds that the National Labor Relations Board did not have a quorum when the so-called “microwave rule” was voted on.

A recent Ziegler survey of senior living providers shows a variety of smoking policies ranging from somewhat to very restrictive.

In no communities of those surveyed can a resident smoke anywhere on campus, while in 34%, residents can’t smoke anywhere on campus. Nearly 10% of communities say they deny admission to smokers.

Nearly one-third (31%) allow residents to smoke in designated areas, and 37% allow independent living residents to smoke inside of their units.

Most communities reported that their smoking policies didn’t have much of an effect, negative or positive, on either their sales or occupancy, according to the survey.

Source: Ziegler Investment Banking: Senior Living CFO Hotline

Ziegler says organizations cited a variety of reasons for instituting smoking policies, including state law mandates, concern from non-smoking residents, and the belief that smoking conflicts with the organization’s wellness initiatives.

Written by Alyssa Gerace

New research suggests that feeding tubes can cause or worsen pressure ulcers in elderly dementia patients — a finding that contradicts the commonly held belief that feeding tubes promote healing.

Federal officials revealed more specifics on the Obama administration’s Alzheimer’s initiative, including details of two new clinical trials.