Senior Living News Wire

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.

Some aging rockstars find it difficult to give up their accustomed lifestyle of sex, drugs, and rock & roll, and in an interesting twist, a significant number of older adults are heavily partaking in sex, drugs, and alcohol as they transition into their newest phase of life. While they’re not quite rock stars, the number of people aged 50+ in treatment for addiction to be “drastically on the rise,” a recent survey found.

Previous studies have found that as many as 80% of adults aged 50 to 90 remain sexually active, with the number of sexually transmitted infection or disease cases more than doubling between 2000 and 2009 in that age group. And seniors aren’t just having sex: they’re drinking and using drugs, too. 

Addiction levels will continue to rise—leading to an epidemic among older Americans—unless there’s more early intervention and treatment, says the Hanley Center, a drug and alcohol treatment center owned by Caron Treatment Centers.

The number of older adults who reported using illegal drugs within a year nearly doubled between 2002 and 2007, according to the Substance Abuse and Mental Health Services Administration.  

While most survey respondents (79%) reported their first experiences with drugs or alcohol occurred before the age of 25, 40% said they didn’t become substance abusers until after age 48. Many named prescription drugs (49.5%) and alcohol (90%) as their substances of choice. 

The survey found depression or anxiety to be the number one reason older adults abuse drugs or alcohol, with other factors including economic or financial stress and retirement.

“Older adults face a distinct set of challenges as they enter their golden years,” said Dr. Barbara Krantz, Medical Director of Hanley Center, in a statement. “This transitional period of life is unique and leads to difficulty in dealing with stressful situations, such as an early retirement or financial strains, which in turn may lead to serious anxiety and depression. Without the proper tools to manage their emotions, older adults turn to quick fixes such as alcohol and drugs, creating the perfect storm for dependency.”

Cannabis Advocacy Group Searching for Senior Potheads in Fla. Retirement Communities

While the Hanley Center is calling for intervention for older drug users, cannabis activist group Silver Tour is going in a different direction.

The group is traveling to senior living communities in Florida in an effort to drum up support among seniors for legalizing marijuana, writes the Wall Street Journal. 

Silver Tour’s goal is to persuade older adults to support legislation legalizing medicinal marijuana, arguing from a platform that pot is “just what the silver-haired set need[s] to combat conditions like chronic pain and insomnia.” 

Robert Platshorn, who founded Silver Tour in 2010, served nearly 30 years in prison for his role in a 1970s-era marijuana-smuggling ring, WSJ reports. 

Mr. Platshorn, 69 years old, decided to focus on his fellow seniors—a group that isn’t exactly high on the idea of medical marijuana. People who are 65 and older helped sink a 2010 ballot initiative to legalize pot in California, voting 66% against it, more than any other age group, according to exit polls.

“Nobody in the marijuana movement is talking to seniors,” Mr. Platshorn says. Yet “seniors are the only damn people that go to the polls.” In Florida, people 65 and older represent 24% of eligible voters compared with 18% nationally, according to a Pew Research Center analysis of census data.

Seventeen states and the District of Columbia have enacted laws to legalize marijuana for medicinal purposes, says Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws, an advocacy group. Six more states debated legalization bills in legislative sessions this year, he says.

The activists’ initiative has not been warmly received in Florida’s Republican-controlled legislature, which has traditionally opposed pot legalization. 

Only a small percentage of the 65+ crowd use marijuana for either recreational or medicinal purposes, says the article, citing a 2009 Substance Abuse and Mental Health Services Administration report. In the 50-54 age demographic, though, that number rises to 6.1%—indicating that pot usage may rise among seniors as the baby boomers age, the WSJ suggests. 

Read “Joint Effort: Reefer Roadshow Asks Seniors to Support Medical Pot,” or revisit “Booze, Sex & STDs in Senior Living Facilities.” 

Written by Alyssa Gerace

The percentage of older Americans living below the poverty line has been growing steadily since 2005, and many are falling into poverty as they age and spend down their savings, especially on healthcare costs and nursing homes, according to an April 2012 EBRI (Employee Benefit Research Institute) analysis of a health and retirement study. 

Between 2005 and 2009, poverty rates began rising in correlation to the economic recession; during this period, more seniors fell into poverty, with blacks, Hispanics, and single women facing higher poverty rates compared to other seniors. 

As the population ages, medical expenses factor heavily into exhausting many seniors’ resources, and the chance of suffering a health condition (acute or otherwise) rose 45 to 55% for those beneath the poverty line, the EBRI study found. 

For seniors living in poverty, 96% have experienced some sort of health condition (high blood pressure, diabetes, psychological problems, or arthritis) compared to 61.7% of retirees with incomes placing them above the poverty line. 

“Medical expenditures go up for the elderly as they age and medical expenses have been rising over the past decade very rapidly,” says Sudipto Banerjee, a research associate at EBRI and author of the report. “A lot of people have to move to nursing homes, and nursing homes are very expensive. People who live there, they lose their income and assets very quickly.”

During tough economic times, many retirees end up spending down their assets too quickly, but Banerjee expects that the poverty rate will go back down as the economy improves. 

Written by Alyssa Gerace

American nursing homes have been, and for the most part still are, very institutional settings that can even be compared to asylums, according to The Atlantic, but the tides are turning as a culture shift toward person-centered care begins to sweep through the industry.

More than half of the nation’s nursing homes are committed to a culture change, according to nursing home trade groups the American Health Care Association (AHCA) and The Alliance for Quality Nursing Home Care, where nursing home residents’ values and wishes are “seriously considered and honored,” rather than having daily operations running in a uniform, regimented manner. 

Most agree that implementing culture change could have a powerfully positive impact on improving the quality of residents’ lives, but there are some barriers that exist in the form of incompatibility with current regulations and even liability on behalf of nursing homes.

The nursing home industry is the second-most regulated sector in the U.S., topped only by the nuclear power industry. That means there are a lot of rules governing how nursing homes are run, and that can get in the way of person-centered care. For example, beds can only be located in certain spaces in units, making it difficult for residents to rearrange their furniture to suit their personal tastes, says The Atlantic.

There are also regulatory prohibitions on open kitchens, meaning residents aren’t able to just go fix a snack whenever they want to. “If we are serious about making nursing homes more comfortable and homelike, a review of existing regulations and amendment or removal of those regulations that impede culture change must be put into place,” say the article.  

Sometimes, though, the biggest barrier to culture change in nursing homes is not the actual wording of the regulations but rather the often inconsistent, incoherent, and uninformed way that the regulations are interpreted and enforced by government employees who regularly survey facilities and cite them for perceived noncompliance. The new QIS process may help. But it will in no way diminish the imperative for intensive, ongoing education of government surveyors to inculcate them with the principles and goals of culture change and a commitment to performing their quality oversight function in a less punitive and more collaborative mode. Pilot efforts in this regard established by the Rhode Island health department’s nursing home survey agency may serve as a useful model for other states.

Finally, we must address the legitimate anxieties of nursing home owners, governing boards, and hands-on personnel about potential lawsuits if a more homelike environment results in residents’ suffering injuries as a consequence of their own choices. Courts and personal injury attorneys need to be educated so that they will embrace nursing home practices that embodying the new standard of care to which providers should be held legally accountable. Compliance with culture change-driven standards of care should be recognized as a defense to claims of negligence. The best way to ensure this would be legislation codifying the legal weight given to these standards.

Ultimately, the institutional settings of the past are no longer acceptable, and if the industry is serious about improving the lives of its residents, there’s going to need to be a change not just in culture, but also in regulations to accommodate “necessary innovation.” 

Read the full article here. 

Written by Alyssa Gerace

A program meant to transition nursing home residents out of institutional care and into their own communities is not meeting projected transfer rates, a national analysis finds.

A program meant to transition nursing home residents out of institutional care and into their own communities is not meeting projected transfer rates, a national analysis finds.

A consumer group is pointing an accusatory finger at the nursing home industry for reporting “staggering” first quarter earnings, while more than a third are providing “lousy” care.

In their first quarter earnings reports, many publicly-traded companies operating skilled nursing facilities spoke of “record revenues” and “operating profits that exceeded expectations,” points out Brian Lee, executive director of citizen advocacy organization Families for Better Care. 

“Nursing home owners are obviously ‘coping’ from last year’s Medicare adjustments through progressive acquisition strategies and imaginative cost mitigation techniques,” said Lee. “What’s also bolstering their profitability is a stronger Medicaid reimbursement rate, growing two percent over the past year.”

In April, Families for Better Care made similar comments about the skilled nursing industry, bashing it for turning “astonishing” profits while delivering “inferior care.” At the time, Lee said much the same thing: nursing homes had expressed a lot of concern about the Medicare cuts that went into effect last October, but seemed to mitigate those cuts in the fourth quarter. 

The biggest concern for the advocacy group is that, despite turning profits, the industry is doling out “substandard care” in about 35% nursing homes that have “below average” or “much below average” scores, according to Medicare’s Nursing Home Compare data.

“Strong margin calls may appease shareholders and investors, but many residents are languishing from pressure sores, broken bones and the overuse of antipsychotic medications,” Lee says. “Facing a 1 in 3 chance of being admitted into a lousy facility is a daunting proposition for consumers.”

The industry needs to find a way to balance profitability and quality of care, says Lee, who called for greater transparency and disclosure from nursing home companies, along with a restructuring of the payment system.

Around the same time of the consumer group’s comments, newly-released government data indicated that nursing home quality ratings are improving. Looking at more than 15,000 facilities, the Centers for Medicare & Medicaid Services (CMS) reported that its five-star rating system for skilled nursing facilities showed that the number of four- and five-star centers has increased by 4% and 4.1%, respectively, while the number of one-star facilities decreased 7%. 

“Quality is a continuous journey for our members, who strive every day to meet the needs of our residents and their families,” said Mark Parkinson, president and CEO of the American Health Care Association. “We’re excited about this positive trend, and will continue to work with CMS to do more in these critical areas.” 

Written by Alyssa Gerace

Private equity firm Vista Equity Partners recently acquired Silverchair Learning Systems, a provider of an online education and communications system for the senior care industry, from Silverchair Holdings, Inc. 

Vista, which has more than $6.6 billion in committed capital, focuses on investing in software and technology-enabled businesses, and is growing its e-learning platform with the Silverchair Learning Systems acquisition. The senior care industry education and communications system joins Vista’s newly-formed online learning program alongside Essential Learning, a provider of e-learning solutions for behavioral and community health, substance abuse, corrections, developmental disability, and child welfare organizations.

The two companies will continue to operate as separate business units and will continue to innovate in their respective markets, but will benefit from the ability to collaborate in order to provide market-leading products and tech platforms for their respective customer bases. 

The acquisition gives Silverchair strong financial backing to support its growth, and also gives the company access to Vista’s knowledge of the industry as well as its best practices and its track record in creating “world-class” software business. 

Now that Silverchair Holdings has sold off its Learning Systems platform, it plans on “calibrating” its vision and resources by accelerating technology investments, maximizing market opportunities, and building market share in the scientific, technical, and medical information and knowledge management space. 

“Today’s transaction is part of our long-term strategic plan to focus on Silverchair’s core competency of developing innovative technology platforms for STM publishers—a market we have successfully served for nearly 20 years,” said Thane Kerner, CEO of Silverchair Holdings. “This transaction will accelerate our development of the technologies that help make our publishing partners successful by both providing additional funding and by bringing a singular focus to our business.”

Harris Williams & Co. acted as Silverchair Holdings’ exclusive advisor. 

Written by Alyssa Gerace

The U.S. Senate did not approve legislation that would strengthen regulations for antipsychotic use in nursing homes, despite overwhelmingly passing a bill it was attached to on Thursday.

Death rates associated with strokes are declining, but lifestyle differences and socioeconomic forces are keeping people in Southern states more susceptible to strokes, researchers emphasize in newly released findings.

Several senior living communities across the nation have introduced a continuing care retirement community (CCRC)-without-walls model of care, meaning that seniors can remain in their homes and receive the same continuum of care services they’d get had they moved into a traditional community, using a similar contract structure.

While most people entering a traditional CCRC pay the entrance fee using proceeds from their previous home’s sale, this new model keeps seniors in their homes—but still has the entrance fee component, which Stephen Maag, Director of Residential Communities at LeadingAge, found ranged between $20,000 to $70,000 among existing programs in a February 2012 paper on the model. 

This could pose a problem for many seniors on fixed incomes. While AARP studies show about 90% of older adults want to remain in their own homes for as long as possible, two-thirds of Americans fear they won’t have enough money for retirement, and nearly half fear they won’t have enough to pay medical costs for normal healthcare, according to a Gallup poll.

That’s where reverse mortgages come into play. Using this type of loan to finance the buy-in to a CCRC-without-walls program “could very easily” be the solution to being able to afford the entrance fee, says Dennis Baier, a mortgage broker specializing in reverse mortgages at Chicago-area Wintrust Mortgage Corporation.

Reverse mortgages, which allow homeowners aged 62 or older to tap into their home’s equity, can be used for a variety of reasons: to free up monthly cash flow, pay off an existing mortgage, make repairs to the home, and perhaps above all, allow people to stay comfortably in their homes. Through this type of loan, borrowers are able to get a loan based on their age and their home’s value, among other factors, that can be in the form of a lump sum, monthly payments, a line of credit, of a combination of these options. 

“The whole point of a reverse mortgage is keeping a senior in their home and keep them comfortable and familiar in their surroundings,” says Baier, who’s also a part of a task force committed to helping seniors transition from home into retirement living.

New model of CCRCs

The CCRC-without-walls program is not exactly a brand-new concept—they’ve been around since the late 1980s. But development has been slow, says Maag, with factors including the economic recession and a lack of understanding of the program.

There are currently about 12 existing CCRC-without-walls programs in various stages of development or implementation, Maag estimates, and at least a few have been around for a number of years. Others, like the program started by Evangelical Homes of Michigan, are more recent and were begun within the past couple years.

It’s important to distinguish this model from other CCRCs that have programs providing services to seniors in their homes, ranging from home health care to personal care to chore services, Maag points out.

“The important difference is a CCRC without walls program takes the concept of the life care contract and a bundle of services into the home,” he says in February 2012 paper about the model. “A CCRC without walls contract is a comprehensive approach to providing the health and wellness lifestyle to seniors in their homes. It is not just services which can be purchased on as needed basis.”

Reverse mortgages and at-home care

Ultimately, reverse mortgages don’t work for everyone, and they won’t necessarily work with this CCRC model, Baier says. 

“In general, it’s a good idea,” says Norma Coe, associate director for research at the Center for Retirement Research at Boston College. “There is one concern, though, especially when you get to a stage where you need 24-hour care: It’s more expensive to be [providing] it at individual houses.”

The issue is that while a reverse mortgage lump sum may initially help seniors buy into the CCRC model, they might not be able to sustainably afford the monthly fees which may increase as the level of care they need intensifies.

It’s difficult to calculate the premiums for more intensive care, Coe says, adding that it’s “more about the [CCRC] model than whether reverse mortgages are able to pay for it.”

Still, using a reverse mortgage could definitely be an option for those who have high-valued homes, as they have more equity to draw down.

Because most of the CCRC-without-walls programs are relatively new, it’s still unknown how the model will work when people get into the higher (and more expensive) levels of care, and methods for payment vary.

“At Evangelical Homes of Michigan we try to provide a variety of options and solutions to assist clients in managing payment of their entry fee for a LifeChoices membership including various payment plan options,” said Denise Rabidoux, president and CEO of EHM. “To date we have not had a client approach us to discuss reverse mortgage as an option.”

EHM, along with certain other CCRC-without-walls providers, hasn’t yet reached the point where “residents” need skilled nursing, according to Steve Hopkins, the vice president of Wellness and Home-based Solutions at EHM.

But receiving care at home is a “very desirable” commodity, Coe says, and demand for this commodity will likely continue to grow.

Written by Alyssa Gerace

Three times, Covington Investments, LLC proposed to buy out Advocat, Inc. (NASDAQ:AVCA), and three times the skilled nursing operator said ‘no.’ But now some angry Advocat shareholders are suing the company for rejecting Covington’s takeover bids.

In letters sent on Feb. 27, March 22, and April 12, 2012, Covington made proposals to acquire Advocat, eventually writing a public letter dated May 11 complaining that Advocat hadn’t shown any interest—which it owed to its shareholders—in such a transaction. 

The investment firm increased the value of its proposals, reaching $8.50 per share (for $44 million, considering the 12% of shares already owned by Covington affiliates), which it contended represented “extraordinary value” to the operator’s shareholders considering it was a 96% premium above the previous day’s closing stock price of $4.34.

Advocat wrote back to Covington in a letter dated May 11 saying that its board “takes its fiduciary duties very seriously” and that it had decided not to pursue a discussion after thoroughly evaluating the proposal. 

The board determined the proposal was not in the shareholders’ best interests at the time, according to Advocat’s president and CEO, Kelly Gill. 

“The Board believes that stocks in our industry, and Advocat’s stock in particular, are currently undervalued by the market and that the implementation of our strategic initiatives is the best way to enhance value at this time for all shareholders,” Gill wrote in the letter. 

However, the plaintiff alleges in the complaint that Advocat breached its fiduciary duties by rejecting the most recent offer by Covington, claiming the operator “refused to even consider” the proposal. 

The lawsuit has been filed by a local plaintiff law firm Barrett Johnson, according to the Nashville Post, and claims that Advocat’s board has “engaged in misconduct by employing various ‘draconian antitakeover defenses’” in the past.

Written by Alyssa Gerace

With the shift to electronic health records comes the promise of safe and secure resident and patient records, right? Not necessarily. Protecting personal health information goes beyond new technology and meeting compliance mandates. While new technology and ongoing network health assessments are essential, equally as important is the readiness of clinical staff in adopting new practices that protect the integrity of health records.

Senior living and personal care communities need to be prepared for the shift in consumer behavior. With the shift come questions like, “How safe is my medical information?” “Who has access to my information?” And, “How will you ensure that my personal medical information remains safe and private?”

Following are a few steps communities can take to ensure they’re fully prepared for the change – both technologically and culturally.

Don’t forget the basics

In the past, the clinical staff was not widely required to use technology-forward devices, such as laptops, tablets or smartphones. Although young nurses tend to be more tech-savvy, and the devices continue to penetrate consumer lifestyles, community administration should not assume that all staff members are equipped with the knowledge and experience to manage such devices.

Know that there will likely be a learning curve with both the devices and the new software. Implementing training programs can be an effective solution, and many technology providers that facilitate the shift to electronic health records can help communities with the necessary training.

Embrace the “perks” of EHRs and teach staff to do the same

One of the greatest benefits of electronic health records is increased accuracy in patient care. Electronic records provide greater visibility into patient care such as the frequency and amount of medication administered, tracking of vital signs and identification of inconsistencies and abnormalities.

However, nurses and clinical staff trained to use paper records may not be acclimated to new processes. Without consistent oversight possible in the management of paper records, clinical staff could track patient information at the end of their shifts, or upon return to the nursing station.

To fully leverage the advantages of a digital records environment, and to deliver the highest quality of care to residents and patients, clinical staff needs to be trained to use the devices accurately, which means entering information as care is administered.

Make security part of the culture

Addressing obvious security concerns should involve new technology and a change in the culture of the organization. Work with your technology provider to be sure the right layers of security are in place – including authentication processes, the encryption of records stored on mobile devices, and others. But, know that security goes beyond technology and technical security processes. Patient records are only as safe as the practices being implemented.

Staff should be aware of the impact their actions can have on the security of resident health records. Lending out credentials, like passwords and physical access devices, can be considered a breach of security. Loaning credentials to a coworker or friend who in turn accesses the information maliciously can cause consequences that fall back on the credentialed user. Teach staff that access to personal information should be protected, and that when it is not protected, the community, its residents and the staff member can be faced with serious consequences.

Hold Staff Accountable

While device management and security process training is essential, it might not be enough. Policies need to be put in place that not only educate but also include consequences for willfully compromising the integrity of patient health records. Policies should be tailored to a community’s mission, and hold staff accountable for continuing education and training, as well as safe security practices. When everyone is working together as a team, toward the same goal of keeping patient health information private and secure, it boosts confidence in the community for its residents.

With the mandated deadline for EHR transitions fast approaching, senior living and personal care communities across the country are continuously recognizing the advantages and challenges associated with the shift. Communities that make the extra effort to ensure that staff are properly trained and security is woven into the fabric of the community will experience a smoother transition, better protecting the integrity of private resident health information.

Written by Dennis Stufft, President at Prelude Services

Carrying a strong stigma in India where traditionally, families care for older members of society, senior living and care communities are beginning to take rise, the L.A. Times reports. Still far from senior living options in the U.S. and Canada, the demographic shift in India indicates the new trend may be a lasting one. 

The L.A. Times writes: 

India, a nation that prides itself on the inclusive embrace of its extended families, is slowly accepting a feature long common in the West: elder-care facilities.

Social changes find more urban families rejecting traditional arrangements involving grandparents, parents and children under one roof, preferring life without nosy in-laws. Economics is also playing a role as more professionals work abroad or in large Indian cities, too busy to care for aging parents.

But things work both ways, sociologists say. More older people also prefer living with others their age, even enjoying a bit of romance away from the disapproving gaze of grown-up children.

“Life here is easier than living with my family in all respects,” said P.V. Bhaskasan, also a retired teacher. “There’s too much fighting in extended families.”

As India’s traditional social contract frays, however, seniors are also more subject to neglect, physical and mental abuse and depression. In 2010, 11,100 people older than 60 committed suicide, a 20% increase from 2008.

“In abuse cases, parents don’t want to come out against their own children,” said Anjali Raje, deputy executive director of the International Longevity Center in Pune. “So it’s swept under the rug.”

The idea of senior homes has long carried a stigma in India.

…But the picture is changing, with the number of India’s people older than 60, now at 96 million, expected to double by 2030. Critics say government planners are so enamored of the “India shining” narrative of its young people that they all but ignore the demographic shift.”

Read the original article. 

Written by Elizabeth Ecker