Senior Living News Wire

Making sure senior living community residents are safe is a top priority for operators, and while new technology is being developed to facilitate this goal, there’s also a question of the appropriateness of monitoring independent living residents.

Much of the new technology centers around helping residents remain safely independent, but while it can be a lifesaver for some, others question whether it goes too far. For Rick Cumberland, a senior vice president at Greystone Communities, there is a fine line.

“It’s a delicate balance,” he says, adding that achieving this balance differs from provider to provider. For Greystone communities, his company believes in its responsibility to provide a safe environment but has chosen not to directly monitor its residents’ whereabouts.

It can come down to the issue of intrusion versus liability. Residents want to live independently, but especially for those who are older, there are troubling possibilities of slipping and falling, or suffering a stroke or heart attack, without anyone to assist or check up on them.

It all comes down to residents’ choice

Greystone residents can choose to wear a personal emergency alert device, in a wristwatch or neck pendant form, that allows them to press a button in case of an emergency.

At a few of Greystone’s independent living communities, residents can also opt in to pressing a button or making a phone call each morning to let staff know they’re OK, in addition to wearing the personal emergency device.

That’s similar to what Tulsa, Okla.-based senior housing and care provider Gold Medallion offers at Broadmoor Retirement Community, the independent living portion of its continuing care campus.

Each apartment comes equipped with a system that allows residents to punch a button when they get up in the morning and before they go to bed, to let the provider know they’re alert and well.

“If they haven’t punched a button by a certain time, we go find out why they haven’t, or call on our intercom system,” says Diane Hambric, president of Gold Medallion. “That gives us the security of knowing they’re not laying on the floor and have had a stroke or a heart attack. With the increased acuity, you have to be sensitive to it—but it is a fine line.”

Gold Medallion spent about $400,000 installing the communications system into its three senior living and care communities, and Hambric acknowledges that not all providers are willing to invest that kind of money into a system, especially in independent living communities where residents are supposed to be on their own.

So far, residents are happy to participate in the limited monitoring, and Hambric says her company hasn’t encountered anyone who disagrees with letting someone know they’re up and about for the day, or are turning in for the night. “We’ve saved some people’s lives with that system when they didn’t answer,” she says.

What happens if the system fails?

There is always a risk that the system will fail, and that no one will notice that a resident hasn’t pressed a button until it’s too late.

This can be a complicated issue, says Paul Gordon, a partner at San Francisco, Calif.-based law firm HansonBridgett, and it can come down to a provider’s responsibilities and obligations.

Take for example a resident in a community with a communications system that also gives people the option of wearing personal emergency alert devices. If that resident chooses one day to not wear that device, and experiences some sort of medical trauma that goes undetected by the community for any period of time, the provider can’t necessarily be held liable.

“An operator is not responsible for an independent resident’s failure to use a safety device,” he says, although he adds that in assisted living, there’s “generally an obligation to monitor the resident’s use of such a device to the extent reasonably feasible.”

And if the personal emergency response system device itself fails, the manufacturer is held legally accountable for equipment malfunction, says Gordon.

When do communities go too far?

At Greystone communities and at Gold Medallion’s campus, the technology employed is non-invasive in nature. But it can be difficult to draw the line as far as what kind of monitoring works best.

“It’s a complicated problem,” Gordon says. “You need to have consent—in writing—of the person who is being monitored, particularly if the monitoring involves video cameras.”

In places where residents have an expectation of privacy, such as in their rooms or private living quarters, it’s extremely important to disclose monitoring. “People generally don’t like to be monitored, period, in their own homes,” Gordon says.

But in hallways, campus grounds, or parking lots, there isn’t much of an expectation for privacy, and in these places video monitoring could be acceptable.

Be upfront about the services offered

In any event, it’s best to communicate clearly to incoming residents what monitoring is available, whether or not someone chooses to utilize it. “Clarity and disclosure is very important,” says Gordon.

In Greystone communities, residents are not required to wear any sort of emergency alert device, and some choose not to.

“We ask them to sign a waiver [indicating] we’re not responsible for an accident that might happen where they can’t notify us,” says Cumberland of the residents who don’t want to wear a personal safety device, or who opt out of notifying the provider when they’re up for the day. He adds that residents consent or sign a waiver to the kind of security system a particular community offers upon entering.

Different providers generally have different philosophies when it comes to keeping track of independent living residents.

Some make it clear they have no responsibility at all to monitor their residents and are strictly providing a place to live, along with whatever other non-healthcare services they may offer, says Gordon, adding that in many cases independent living residents are free to purchase their own alert systems or hire a private duty aide to stay with them.

Options seniors can consider on their own

“There’s technology out there that families can buy,” confirms Andrew Carle, a former senior living administrator and founder of George Mason University’s senior housing administration program. “The provider shouldn’t be a broker of these technologies, but they should be aware of them. They can allow home health agencies to come into the community, but they shouldn’t broker those agencies.”

For residents wishing to remain in independent living for as long as possible, technology is “clearly” the answer, he says. “There’s no reason people can’t remain for longer, and sometimes significantly so, by using technology such as medication systems, PERS [personal emergency response system], even GPS shoes.”

Some manufacturers have released their own medication dispensers, where an individual’s specific medications are placed in pill cups on a carousel that can be pre-programmed with reminders for taking those medications at a certain time each day.

Other companies, like Intel-GE Care Innovations, are introducing programs with a preventive mindset to focus on keeping seniors healthy and well rather than treating them once they become sick or develop chronic illnesses.

The Care Innovations systems can often be used by residents in independent living settings who want to participate in remote monitoring, manage chronic illnesses, or connect socially with others.

For communities that don’t offer any sort of safety systems or options, residents can take advantage of products like Life Alert, a medical alert system designed to help keep seniors independent, or, as Gordon and Carle mentioned, hire a third-party home health agency.

Know your risks

When it comes to what a provider could be held responsible for, the best advice is to talk to a lawyer, says Carle.

“Make sure you don’t place yourself in a risky position by assuming, either intentionally, or in a de facto manner, responsibility for something in which you should not be involved,” he says.

Years ago, Carle says he came across an independent living community that had pull cords in apartment bathroom units for residents in case of an emergency. But the people who answered those pull cords were maintenance staff—not licensed caregivers.

Independent living communities generally aren’t licensed to be providing healthcare, so it’s important to determine who, exactly, would be responding to a resident’s emergency call.

At Greystone, the personal emergency alerts predominantly go directly to 911, or a professional paramedic or EMT.

“It doesn’t conflict [with not being a licensed healthcare provider] because we’re contracting with licensed providers,” Cumberland says. “We’re not administering care; we’re merely serving as vehicle to get appropriate emergency care.”

Written by Alyssa Gerace

This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit www.alfa.org.

Providing healthcare services and retirement benefits to the nation’s enormous baby boomer population will place a huge burden upon the economy, says the Congressional Budget Office in its 2012 Long-Term Budget Outlook. 

“The aging of the baby-boom generation portends a significant and sustained increase in the share of the population receiving benefits from Social Security, Medicare, and long-term care services financed by Medicaid,” writes the CBO. 

Although the CBO analyzed two scenarios spanning a wide range of possible policy choices, neither represents what the agency predicts policies will actually be during the next several decades. Either way, whichever scenario (or version thereof) ends up in place, the nation’s debt profile is going to get real ugly.

Federal debt will take up a whopping 70% of the nation’s gross domestic product (GDP) by the end of this year alone. Under what the CBO terms the “alternative fiscal scenario,” debt would reach nearly 200% of the GDP in 2037 as revenues remain at similar levels on a historical basis, while spending grows because of aging and rising health care costs.

“The explosive path of federal debt under the alternative fiscal scenario—which maintains what might be deemed current policies—underscores the need for large and timely policy changes to put the federal government on a sustainable course,” says the CBO. 

If current laws and policy provisions remain in place or in plans for implementation, spending on the major federal health care programs alone will nearly double as a percentage of the nation’s GDP by 2037 and will continue to increase. 

View the 2012 Long-Term Budget Outlook.

Written by Alyssa Gerace

This installment of senior care technology news features Brookale Senior Living’s implementation of Aerohive Network’s wireless network solutions, along with a new tool for assessing proper hygiene among healthcare clinicians and a German company that recently launched an assisted living gateway for independent seniors who want to stay in their homes.

1. Aerohive Networks: Brookdale Senior Living Implements New Wireless Networking Solution

Brookdale Senior Living recently implemented a massive deployment of Aerohive Network’s wireless network solutions to enable higher levels of care with Wi-Fi and EMR and provide wireless Internet access to residents. Aerohive is a pioneer in controller-less Wi-Fi and cloud-enabled networking, and its wireless solution will deliver needed functionality for Brookdale without the need for a controller in each community.

“We’re finding mobility is key for our EMR applications. It gives us the ability to do bedside support and therapy in many locations, without having to be connected by a wire,” said Chris Fadrowski, Senior Director of IT Infrastructure for Brookdale Senior Living.

2. G5: Brand Advocacy Provider Releases Next-Generation DXM Platform for Senior Living Industry

G5, a digital experience management (DXM) provider for the senior living industry, recently announced the release of its next-generation DXM platform, which includes five product suites enabling properties to create, deliver, measure, and optimize digital touchpoint experiences.

 “The digital voice of the customer is increasing in volume, and Senior Living communities need a new kind of strategy to address it,” said Dan Hobin, co-founder and CEO of G5. “The G5 DXM Platform allows owners and operators to manage the digital experience at every touchpoint throughout the customer lifecycle, turning prospects into residents and residents as well as influencers into brand advocates. This next-generation platform reflects our commitment to helping our clients meet the needs of today’s digital consumer.”

3. Healthquest: Touch-Screen Technology Promotes Proper Hygiene in LTC Settings

Healthquest Technologies recently received a patent for its “Safe-Hands Hygiene Monitoring System,” a tool that detects whether doctors have used hand sanitizer or washed their hands before touching patients or connecting medical equipment to a patient, reports eWeek.com. 

The system uses touch screen technology to generate indications of proper hygiene before contact is made with patients or medical equipment. Sensors attached to patients render them as human iPad screens, says Healthquest’s director Dr. Richard Deutsch, which can send signals over WiFi to an iPad-like LCD screen that displaces an animated message and voice notification informing the patient of the clinician’s hygienic status. Read more…

4. Connected Living: Senior Organization Celebrates Improved Digital Access for D.C. Seniors

Connected Living, an organization that helps seniors use technology to stay connected, is celebrating the graduates from its program that provided the D.C. Housing Authority’s Garfield Terrace residents with access to computers, allowing them to stay in touch with their families, neighbors, and building administrators in a safe, private online community. 

“The initiative at Garfield Terrace is a fantastic example of how the public and private sectors can partner for the greater good. By providing our senior citizens with access to technology—and the training and support that is essential to its successful adoption—we’ve broadened their community and given them access to all sorts of new opportunities,” said D.C. Mayor Vincent Gray, who will attend the “graduation ceremony.” 

The program launched with 24 participants on April 10, and the next group of Garfield Terrace residents have already signed up for the next set of classes. 

5. Telekom: Assisted Living Home Gateway for Independent Elders

German company Deutsche Telekom’s Innovation Laboratories has launched a home gateway with features that can help seniors live independently, reports Telecompaper. The Ambient Assisted Living device receives information about situations in which elderly users might need help, such as accidents, and automatically informs care personnel. The new product uses existing infrastructure and is remotely maintained by an operator. 

Skilled nursing facility administrators must have more savviness around therapy documentation to survive increased scrutiny from auditors, a payment expert warned at a McKnight’s Super Tuesday session Tuesday.

Nursing homes and hospitals in Illinois can expect to see their Medicaid reimbursements drop as the state seeks to repair its budget and keep the system from collapsing, the Chicago Tribune reports. But slashing $1.6 billion from the Medicaid program will undercut the state’s efforts for nursing home reform and is “totally unacceptable,” said an angered state senator amidst negotiations between lawmakers and elder advocates.

State officials maintain that reforms passed in 2010 to improve standards of care and safety in nursing homes will still go forward, despite a “series of compromises” that took place last week when nursing home operators agreed to a lower Medicaid reimbursement rate, perhaps in exchange for a level of care by registered nurses that was lower than what advocates had hoped for.

That agreement — crafted behind closed doors by top state officials and nursing home industry representatives — angered state Sen. Jacqueline Collins, D-Chicago, who called it “totally unacceptable.”

“They did an end run around the process. It was a disservice to the democratic process. Clout, money and influence determined the outcome,” said Collins, who was one of 13 senators voting against the bill Thursday.

The compromises and painful cuts, which were applied to a variety of health care programs, were needed to keep Medicaid from collapsing, state officials said.

Under the new law hammered out Thursday, Illinois will move to a Medicaid reimbursement system that pays the facilities more for serving nursing home patients with acute medical needs. The new method — known as the “resource utilization group” — creates a disincentive for housing less-acute patients in institutions, Quinn administration officials said.

In addition, the rate cut is fashioned in a way that further encourages nursing homes to house only seriously ill patients, not those who can be better served in smaller settings, Steans said.

The new rules for staffing levels require that a minimum of 25% of all bedside care must be provided by licensed nurses, with 10% by registered nurses, the article says. Elder advocates had been hoping for a rule that registered nurses must provide at least 20% of bedside care. 

Read the full article at the Chicago Tribune. 

Written by Alyssa Gerace

His name might not be recognizable to most even in the senior housing arena, but despite his absence from the Forbes World’s Billionaires list, real estate mogul Gary Morse is the billionaire “behind the curtains” in control of one of the world’s largest retirement communities, reports Bloomberg. 

Morse’s fortune was built by owning almost every aspect of the Villages. 

Morse owns the local newspaper, a television channel and an AM radio station. His realty company controls 60 percent of the re-sale market in the Villages, whose commercials have been fixtures on the Golf Channel. His bank lends to retirees fleeing south; his insurance company provides them coverage. He even gets paid to pick up the trash and organize tee times. For all his ubiquity, most outside of Florida have never heard of him.

“He’s kind of like the Wizard of Oz,” Andrew D. Blechman, author of “Leisureville,” a book on retirement communities, said in a phone interview from his office in Great Barrington, Massachusetts. “He’s the man behind the curtain. No one really knows him at the Villages.”

In 2011, the Holding Company of the Villages Ltd., which is owned by Morse and his family, generated at least $550 million in revenue, according to regulatory filings. Based on the value of his various businesses and real estate—plus the almost $1 billion in estimated profits the closely held company has earned over 29 years—Morse and his family are worth more than $2.5 billion, according to data compiled by Bloomberg. He has never appeared on an international rich list, Bloomberg Markets magazine reports in its July issue.

As landlord of the Village’s 4.5 million-square-feet of commercial space, on which are restaurants, retailers, and doctors offices, Morse and his family are sitting on about $400 million worth of property, the article says. 

Bloomberg goes on to mention a 2009 IRS investigation into some municipal bond issuances from the Village network—a source of some of Morse’s billions.

Read “Hidden Billionaire Morse a Man Behind Curtain at Villages.” 

Written by Alyssa Gerace

I learned how to write the Plan of Correction from a more seasoned director of nursing colleague of mine. Odds are there is somebody you know or look up to in the profession who might be able to give you tips or instruction on this. It’s nice to have someone “in person” while doing one.

While most U.S. nursing homes have adequate written plans for managing natural disasters, many have significant gaps in preparedness and response, a government report finds.

As the number of people who choose nursing homes for end-of-life care continues to rise, more quality measures are needed to help consumers judge performance, a new study recommends.

Moody’s Investors Service upgraded Sabra Health Care REIT in mid-April after the long-term care landlord posting its second-best performance in the first quarter, with a total return of 38.8%.

Consumer advocates in Kansas are concerned about a series of decisions by Gov. Sam Brownback (R) to appoint nursing home industry veterans to high-level Department of Aging positions.

We have an outside food management company and lately, frankly, they’ve done a lousy job. We’re thinking about suing them — good idea or bad idea? What if a resident suspects food poisoning?

The Internal Revenue Service is attempting to recoup $8 million from a convicted former Rhode Island nursing home executive, signaling a warning to providers that they can be held liable for misdeeds.

In another strike against the traditional nursing home census base, a federal judge in Maine has approved a class-action lawsuit settlement that lets those with long-term disabilities live in their home or the community.

Since 1995, negative pressure wound therapy (NPWT) has used controlled sub-atmospheric pressure to remove fluids and infectious materials from a wound while stimulating the formation of vessels and drawing the wound closed. Yet, like any therapy, it should be used appropriately, with progress documented accurately and thoroughly to maximize reimbursement and minimize liability.