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A recent column on Townhall.com takes a hard stance countering a multi-part series aired in July that purportedly portrayed the assisted living industry’s dark side.

“Rarely does an investigative report mange to unite industry executives, academics, and regulators in such a way as the recent Frontline/ProPublic Life and Death in Assisted Living,” writes Bruce Bialosky, a political columnist for Townhall who has consulted extensively with senior living companies. “Unfortunately for the producers and writers, they have united all three elements in expressing how their report misrepresented the industry.” 

The one-hour documentary that aired on PBS and an accompanying four-part series co-produced by ProPublica and Frontline delved into the assisted living industry and issues associated with staffing and training.

However, Bialosky in the column questions the series’ agenda and scope, such as why it focused only on Emeritus rather than the assisted living industry as a whole, or in comparison to home healthcare, and why nearly every incident reported on in the documentary and articles happened prior to 2010. 

Additionally, the show and columns focused heavily on federal regulation, despite the fact that assisted living is regulated on a state-by-state basis, but neglected to interview or reference state regulators. 

“One of the things that disappointed me was the lack of referral to the oversight agencies,” Ronald Melusky, director of Pennsylvania’s Bureau of Human Services Licensing, told Bialosky.

Melusky is also the president-elect of the National Association for Regulatory Administration, in which capacity he sent a letter to David Fanning, executive producer of Frontline, prior to the July airing of the documentary. 

“For each of the horror stories presented by [the Frontline/ProPublica] piece, there are thousands of people who live safely and happily in regulated long-term care settings thanks to effective and dedicated public licensing and regulatory administration programs,” the letter said. 

Another point of contention the Townhall column mentions is ProPublica’s claim that assisted living chains like Emeritus have a “powerful business incentive” to attract frailer, sicker residents who can be charged more for their care.

“Contrary to what was expressed in the show and column, you actually want less frail people because they stay longer,” Frank Haffner, president of American Senior Living, told Bialosky. “That reduces all the costs related to turnover of units and the related marketing costs to fill the unit. We are not interested in residents staying three to six months because their health issues determine that. That is more a nursing home model.” 

Townhall intends to continue its look into the Frontline/ProPublica series in the coming days.

Read the full column. 

Written by Alyssa Gerace

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While the senior living industry tends to view “assisted living” as senior-facing, communities labeled as such cover a broad gamut of resident demographics and characteristics, reveals a new national study.

The study, which is the first of its kind, may have strong implications for policymakers and consumers, says Andrew Carle, executive-in-residence and director of GMU’s Program in Senior Housing Administration, which designed and completed the study.

“What we’ve documented for the first time is, ‘What’s going on at a national level?’ What surprised us somewhat was the disparity between traditional assisted living residents in large communities versus small ones,” he says of researchers’ findings after analyzing data on more than 8,000 residents in 2,300 assisted living communities.

Using information gathered from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control, researchers compared data for residents in communities categorized by the CDC as “small” (four to ten beds), “medium” (11-26 beds) or “large/extra large” (26 or more beds).

Small assisted living communities were nearly three times more likely to house “non-senior” residents under the age of 65, the study found, with more than 21% of residents falling into that age group compared to about 7% in larger communities.

However, the smallest communities were also more likely to house residents with Alzheimer’s disease or other memory care needs, at 53%, compared to 41% of large communities, even though those conditions are typically associated with the “oldest old,” or seniors aged 85-plus.

Still, larger assisted living communities were more likely to house older, “traditional” residents: nearly 85% were over the age of 75, while more than half (56%) were older than 85.

The study does not draw any conclusions on the quality of care between communities of different sizes, notes Carle, but it does highlight “very, very distinct” differences in residents of the largest and smallest communities.

“The care required by an older adult with chronic conditions and those who are younger, dealing with severe mental illness or a developmental disability, or those afflicted with Alzheimer’s, is simply different,” Carle says. “What we now know is these specialty populations are being more frequently served within the nation’s smaller communities.”

The CDC residential care facility study specifically excluded any community of any size that exclusively housed the severely mentally ill or developmentally disabled, Carle says, so by definition each community in the study had at least some residents that fit the “traditional” assisted living profile.

Some of the smallest assisted living communities might be completely composed of residents with Alzheimer’s disease and be functioning well, he says, but in theory, according to the study, people with Alzheimer’s are being co-housed with people with severe mental illness or developmental disabilities.

“That should be of significant interest to policymakers and families. At the end of the day you could raise significant questions over whether or not these people should be co-housed,” Carle says. “That’s a very complicated therapeutic milieu. That would require a significant level of expertise and resources to effectively manage.”

Medium-sized communities generally fell between the small and large ones in terms of resident characteristics. 

“There is overwhelming evidence that assisted living is improving quality of life for seniors,” said Rick Grimes, president of the Assisted Living Federation of America, a trade group that sponsored the study. “We see this in the rapid growth in communities nationally and in numerous surveys indicating 90%-plus satisfaction among residents and family members. But there is also a need to document what the populations in these communities look like in order to ensure the right resident is receiving the right services to match their needs.”

With the results of the analysis as a foundation, GMU researchers plan on conducting a second phase of the study comparing specific quality of life indicators of an “average” assisted living resident to “peer acuity” seniors who choose to remain at home. This kind of study would represent the first formal comparison in a nation that’s looking at a rapidly aging population and escalating demand for housing and care.

“Where this helps is in separating what is thought of as a typical assisted living resident from the specialized groups, versus viewing all assisted living communities as the same,” said Carle.

Written by Alyssa Gerace

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The senior living industry and continuing care retirement communities in particular are gaining momentum as a career option for hospitality students as compelling demographics help increase awareness about the sector. 

In early October, a group of senior living professionals gave a presentation on the industry to more than 200 students enrolled in Pennsylvania State University’s colloquium course for its hotel, restaurant, and institutional management program.

“It’s timely, because as the baby boomer generation are retiring, there are more and more opportunities for senior living,” says Professor A. L. “Bart” Bartlett, MBA, PH.D., associate professor and associate director of PSU’s School of Hospitality Management.

The demographic push is coinciding with the university’s recent efforts to make its hospitality students aware of those opportunities, he adds, at the request of a benefactor and alumnus who left a successful career at ARAMARK to be an executive director at a Connecticut CCRC. The alum, Joe Venucci, attributed his continued success at East Hill Woods, Inc. to his hospitality orientation, Bartlett says, and encouraged PSU to look into similar opportunities for its students. 

The demonstrated success of two presenters who are executive directors with hospitality backgrounds served to bolster already compelling 65+ demographic projections, says Jim Glynn, owner of marketing and advertising firm GlynnDevins, citing resident satisfaction surveys. 

“The move toward hospitality is very much going to enhance the marketing and sales of communities,” he says. “It will be more and more a place where people know they want to go, because the hospitality is good, instead of thinking ‘I’m not ready for that yet, I’ll wait til something happens.’” 

Between 150 to 200 students graduate each year from PSU’s hospitality program, with about 250 currently taking the colloquium class. While Bartlett expects the majority will continue going to well-known hotel and restaurant employers such as Marriott, Hilton, and Darden, a growing number are expected to look to senior living as an alternative career track. 

“Senior living will likely always be a niche in our student body,” he says. “But it’s definitely on a positive trajectory. It’s just at the beginning stages.”  

PSU’s hospitality program offers “Hospitality in Senior Living” once a year, mostly concentrating on the management of continuing care retirement communities. 

The first time the class was offered, it was titled “Managing CCRCs,” recounts Bartlett, and only 22 students enrolled, in large part because they didn’t know what a CCRC was. The class is being offered again under the hospitality heading, and Bartlett is counting on at least 40 students taking the course.

“I’m optimistic we can have some real positive momentum,” says Bartlett, calling CCRC residents a “very rewarding clientele” who are regularly coming to dinner, ordering from a menu, and know and appreciate quality service and food. 

“As a hotel manager, you try to make a guest’s day, and have them leave feeling better than when they checked in. At a CCRC, you’re not making peoples’ day–you’re making their life,” he says. “You can really make a difference in terms of peoples’ lives while doing all the things you like to with food, services, and lodging. That message has resonated with undergraduates.” 

The approximately 40,000 hotels around the country vastly outnumber CCRCs, of which there are around 2,000, according to LeadingAge, the Penn State professor points out. But according to trade group the Assisted Living Federation of America, there are around 36,000 assisted living communities, often described as the intersection of hospitality and healthcare. 

“We wanted to get across to [the students] the importance of hospitality to attract new residents,” Glynn says. “I think we opened up their eyes to what senior living is about. They have an awareness as to the health side, by it was a real eye opener to see that many residents arrive with no health problems, and successfully age in place.”

Written by Alyssa Gerace 

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Brandywine Senior Living co-founder and CEO Brenda Bacon has been named Chairman of the Assisted Living Federation of America, the organization announced to its membership this week. 

In her role as chairman, Bacon succeeds Mark Ohlendorf, co-president and CFP of Brookdale Senior Living. She brings more than 15 years of experience in senior living, having co-founded Brandywine in 1996 and overseeing the company’s growth across five states and 25 locations. 

“I am both honored and thrilled to serve in the role of Chair,” Bacon said. “While ALFA has come such a long way under past leadership over 23 years, we have so much more we can do on behalf of the senior living business and the seniors in our care.”

Prior to founding Brandywine, Bacon served as chief of management and planning under New Jersey Governor James Florio from 1989 to 1993 where she oversaw health care reform efforts. Her work there also included serving as a senior advisor to the governor as well as on the Department of Health and Human Services transition team for President Clinton. 

ALFA welcomed Bacon to the chairman position and outlined objectives for her term. 

“Brenda is a gifted leader and skilled executive who has built a senior living company from the ground up and has used her knowledge and vision to influence the direction of long term care in our country,” said Richard Grimes, president and CEO of ALFA. “Brenda is the leader who can take ALFA to the next level as we work to advocate on behalf of the senior living business and the families we serve, to be the ‘voice of senior living’, and to help ‘raise the bar’ for excellence in all that we do. As Chair of ALFA, I know she will continue to increase ALFA’s recognition and influence in our service to the senior living business.”

Written by Elizabeth Ecker

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Assisted living providers in Wisconsin can be thankful for a redesigned regulatory approach that has transformed the state’s system for monitoring providers to focus more heavily on those with bad track records instead of imposing an extensive survey on every community, even those who don’t have any serious deficiencies.

It happens in lots of industries—a small percentage of businesses or organizations may misbehave in some way, and as a result the entire industry gets stuck with rules and regulations seeking to prevent that bad behavior from reoccurring. The assisted living industry—at least in some states, as it’s not regulated on a federal basis—is not exempt from this trend.

By most accounts, states are looking at constricted budgets with no indicators of significant improvement in the future. Rather than expending limited resources on unnecessary actions, Wisconsin is focusing on the important: “problem” assisted living communities that aren’t providing the best care to their residents.

A lot of regulatory agencies don’t have enough resources to properly do their jobs, and their budgets are only going to get more strained, agree Jim Murphy, executive director of the Wisconsin Assisted Living Association, and Kevin Coughlin, who up until recently was the Director of the Bureau of Assisted Living in Wisconsin.

“The good thing with the federal part of the regulations is that it also comes with resources,” says Kevin. “That’s a struggle with states. They’re up against these resource challenges.”

He said they’re seeing a number of states looking at the abbreviated survey process that’s been successful so far in Wisconsin, and are focusing their resources on the ones that are actually causing most of the problems. 

“We got forced into re-looking into our systems,” says Coughlin. “Assisted living was exploding in growth, and we weren’t able to keep up with it with our resources.”

He said the rapid growth gave the bureau and opportunity to take another look at how it was handling the industry, and if there was a better way of designing the regulatory program to meet the needs of an “exploding new industry.”

In 2002 and 2003, it restructured the agency, including a critical component: establishing an assisted living forum that got together every month and brought assisted living providers, associations, advocates, and stakeholders in general in one room to address emerging issues throughout the redesign process.

Then, the bureau redesigned the survey process to make it more effective, and introduced an abbreviated system for assisted living communities that have a good compliance history. 

“It gave good recognition to those communities that were striving to do good work,” Coughlin says. “Basically, our approach was, if it looks good, smells good, tastes good, feels good… we’re going to assume it is good.”

Communities qualifying for the abbreviated surveys began to see it as a quality badge, he says, and the redesign process ultimately led to “some really good collaboration” with the associations, especially WALA. 

However, “the state and the [assisted living] providers are not partners,” Murphy emphasized. “We’re collaborators. We have the same goal of quality care for assisted living residents.”

He said that a former WALA executive has used the phrase “creative tension” to describe the relationship between the industry and the state. “We need strong regulations,” he says, adding that in his state, they’re “really” strong.

“Because of that, some issues happening in other states [such as Florida] aren’t happening here,” Murphy says. “[The BAL] has taken a look at the limited resources they have, and have focused on those that aren’t compliant.”

About 87% of assisted living communities in Wisconsin don’t have any serious deficiencies, he continues, so the bureau turns its attention to the approximately 13% that do. 

Regarding Florida, Coughlin says the state has reached out to his state’s Bureau of Assisted Living regarding Wisconsin’s regulatory practices. “They’re incorporating some of the different regulatory initiatives we’ve done into their proposals as they go forward [from the Miami Herald series on the lax regulatory standards for Florida's assisted living industry].”

Statistics are showing time and time again, he continues, that the best—even though they’re not experiencing as much regulatory intensity—continue to be good. 

Providers that belong to the Assisted Living Federation of America and its state chapters are encouraged to look for how they can collaborate with their state regulatory agencies, says Murphy, to make sure they’re paying attention to the industry, and particular attention to the communities that aren’t providing quality care.

“Those are a time bomb waiting to go off, in some states that don’t have these quality care surveys,” Murphy says. “You need to squash the providers that don’t provide quality care.”

Written by Alyssa Gerace 

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