Senior Living News Wire

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

Elderly adults who are deficient in vitamin D are at a higher risk for developing mobility limitations and becoming disabled, new data suggests.

Provider groups are pushing Congress to replace the formula Medicare uses to reimburse physicians and eliminate other regulatory burdens.

Crest Healthcare Supply has released its 2012 online catalog. Features include easy browsing, bookmarking and page-printing capabilities. To facilitate single-product searches, each item can be found in the catalog by simply referencing one keyword. A one-click zoom button is available to focus on individual products, complemented by a gradual zoom bar to allow a closer and clearer picture. The 264-page digital catalog also features informational resources, training videos and new products, including wheelchairs, long term care beds and more.