Senior Living News Wire

Brookdale Senior Living is repositioning many of its units to meet current demand metrics, and it’s trending toward higher acuity, according to the senior living operator’s first quarter earnings call. 

“The product that is coming into the investment profile tends to be a higher acuity product. There’s a fair concentration there of adding assisted living where we only have independent living, adding dementia care where we only have assisted living, adding skilled nursing in markets,” said Mark Ohlendorf, co-president and CFO of Brookdale, during the call. “So the rates are going to be higher in any case. But the returns, I think, are at or above what we had expected, below the mid-teens or looking like good numbers.”

In some of the company’s retirement communities where Brookdale has converted independent living to memory care, it’s seeing higher occupancy rates and revenues. “We have seen as high as almost a 20% increase in the independent living rates, once that project is completed at a non-converted basis based on the strength of that repositioning in addition to getting the higher revenue and gross margin dollars out of assisted living and Memory Care,” said CEO Bill Sheriff. 

On creating a care continuum: Turning some independent living units into higher acuity care can in some cases make the independent living units that are left more attractive, according to the CEO, citing an example of converting some retirement center units into assisted living and memory care.

“It strengthened the IL product component. And in many acquisition opportunities out there, they… have that kind of opportunity to make that home product more attractive, make independent living more attractive because it has assisted living and Memory Care available to it,” Sheriff said.

Basically, residents appreciate being able to stay in one community as they reach higher levels of care, and Brookdale benefits from the “higher gross margin dollar and return factors” it gets from an assisted living and memory care component of a campus setting. 

“We like the perspective of looking at products all the way across the spectrum,” he said. 

On modifying communities to reflect current trends: What’s happening is that as people are living longer, more are experiencing multiple chronic conditions and increased physical limitations, along with memory impairments such as dementia of Alzheimer’s-related disorders. 

Across the industry, more than half of those moving into independent living (51%) have walkers or wheelchairs, according to Sheriff. Considering that and the fact that the nation’s oldest cohort is expanding considerably, there will be an increasing element of needs-based care, he said during the earnings call, adding that this means Brookdale needs to change its units accordingly.

Brookdale plans to modify some of its common areas as well to accommodate “the next generation of elderly coming into our market” who have some different expectations on what retirement living looks like, he said.

In the past nine months, the operator has completed eight “Program Max” projects, encompassing nearly 1,800 units and adding 159 new units; it’s currently working on 17 projects encompassing another 1,700 units, and will add 400 new units in the next year. Additionally, another 19 projects are in the approval process, encompassing 4,000 units and adding 800 more.

Brookdale has spent $13 million of cash equity and said it continues to expand to invest between $60 million and $70 million this year on Program Max activities.  

On ancillary services: Brookdale also noted that its home health business has grown, and higher revenue helped soften the impact of the 11.1% Medicare reimbursement rate cuts.

“The actual impact [of the cuts] in the first quarter was about $2.4 million from home health rate change, largely becuase we have a larger caseload now than we did early last year,” said Ohlendorf. 

In the first quarter, Brookdale purchased two home health agencies as part of its growth strategy for an aggregate purchase price of approximately $3.7 million.

On acquisitions: Although Brookdale is busy with its new development of “Sweet Life” campuses, it’s still looking to be active in the market and make opportunistic moves.

“We’ll end up being in a year with a fair amount of transactions,” said Sheriff. “We will still be looking at what really strategically measures little difference in our company.” 

Earnings highlights: In the first quarter ended March 31, 2012, Brookdale reported a net loss of $10.3 million, or $(0.09) per diluted share. This is a slight improvement from the previous year’s loss of $12.3 million and $(0.10) per share. 

Revenues increased about 16% to $683.5 million, mostly derived from resident fees. 

Average occupancy increased 60 basis points to 87.8% compared to the first quarter of 2011, but remained flat from the previous quarter. 

Read the full earnings call transcript. 

Written by Alyssa Gerace 

Where are seniors going after they retire? It’s one question research organization Esri set out to answer in a recent study of America’s changing demographics.

In its exploration of real estate and housing preferences for the 55-plus population, and with the help of U.S. Census data, Esri narrowed down the five counties with the highest projected growth for older Americans. It found St. Bernard Parish, Louisiana would see the greatest increase between 2010 and 2016 (65%) with Geary County, Kansas; Sublette County, Wyoming; Fort Bend, Texas; and Lincoln South Dakota having the next highest increases.

“Developers need to determine which type of seniors they want to target, since housing requirements for seniors are as varied as seniors themselves, with needs based on affluence, age, lifestyle, and geographic location,” Esri writes.

“Tired of dealing with harsh winters and home maintenance, some seniors in colder climates migrate to warmer places or downsize when they retire and their children leave home. This migration, though, has decreased in recent years as the economy has worsened.”

Written by Elizabeth Ecker

One of the most common and longstanding—but also preventable—practices causing serious harm to nursing home residents is overusing antipsychotic drugs, according to testimony during a Senate Aging Committee hearing last week, reports Forbes.

It’s common for these drugs to be used “off-label”—meaning, not as they were intended to be used—and this can both harm patients and costs Medicare hundreds of millions of dollars.

Last year, an investigation by the federal Department of Health & Human Services inspector general found that 14 percent of nursing home residents were prescribed anti-psychotics but 8 in 10 were off-label, and, thus, not for treatment of mental illness.

Still, this is not a simple issue. Sometimes, aides cannot provide basic hygiene for dementia patients without the use of these meds. Patients can be too violent or agitated for an aide to change their diaper or bathe them.

Edelman said the Center is not opposed to all uses of these medications but rather wants nursing facilities to try other solutions first.

Alternatives to drugs can be time consuming and may require special skills. For example, a patient may react poorly to a specific aide—not because the aide is not competent but because there is something about her that triggers agitation. A nursing home can figure this out and make adjustments. But it takes time and training.

A recent study published in Psychiatry Research in 2011 suggested that dementia could be more effectively treated through behavioral therapy rather than by psychotropic drugs, since many delusions suffered by dementia patients actually have a rational basis. 

The researchers found that drugs used to mitigate dementia systems such as delusions can do more harm than good, and these findings could have a significant impact on the way senior living providers respond to dementia patients.

Read the full Forbes article here. 

Written by Alyssa Gerace

This roundup links tech-related article-heavy as multiple news outlets are reporting on the latest technological developments and advances, including how Health Care Reform could impact electronic health record implementation, how consumer community sites are 24 times more likely to adopt social media tools than health organizations, and the battle between the FDA and mobile health apps.

In other senior care technology news, Independa recently closed its convertible note funding at $2.35 million, with plans to expand sales, support, and engineering operations along with marketing efforts to broaden its customer base; additionally, UK researchers are working on vehicle technology to support older drivers, and RediLearning Corp. just made its continuing education webcasts accessible online for purchase.

1. Politico: FDA Meets Mobile Health Technology, Regulation Ensues

“An onslaught of mobile health technology has forced an arranged marriage between smartphone app makers and the Food and Drug Administration—because someone had to regulate them,” reports Politico. “There’s just one problem: Many of the tech wizards aren’t used to FDA supervision. And now, both sides are struggling to figure out how to live with each other.” Read more…

2. LeadingAge: How Will Supreme Court Ruling on Health Reform Impact HIT?

“Experts agree that a possible ACA repeal would not affect the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program, which was authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act,” reports LeadingAge. “However, Sen. Sheldon Whitehouse (D-RI) maintains that a Supreme Court repeal would hamper HIT efforts because ‘the ACA’s payment reforms, pilot projects and other delivery system reforms are built with the expectation of having IT-enabled providers.’”

The Medicare Shared Savings Program/ACOs, a bundled payment pilot depending on coordinated care between acute and post-acute care facilities, and a clause penalizing excessive hospital readmissions all need a “robust HIT infrastructure.” Read more…

3. PwC: Consumers Using Social Media to Find, Review Healthcare Providers

“Patients may be a step ahead of their local hospitals in adopting social media tools, a new report by consulting firm PwC suggests,” reports eWeek.com. “For its report “Social Media ‘Likes’ Healthcare: From Marketing to Social Business,” released April 17, the Health Research Institute at PwC interviewed 1,060 U.S. consumers. The consulting firm found that four in 10 consumers use social media to find reviews of doctors and treatments and one in four posts material about their experience using social tools. Health organizations, such as hospitals, health insurers and pharmaceutical companies, are behind consumer community sites in adopting social media tools, PwC reported.” Read more…

4. Independa: Telehealth Solutions Provider Closes Convertible Note Funding at $2.35 Million

Telehealth solutions provider Independa recently closed its convertible note funding at $2.35 million, an investment surpassing its $2.2 million target, indicating “strong affirmation” of the company’s strategy to offer integrated technology solutions that help seniors live independently.

In addition to the $1.6 million in seed-round venture capital funding Independa announced last September, the company got another $750,000 in backing, and is now engaged in discussions with venture capital firms and strategic investors on a round of equity-based venture capital. 

The funds will be used to expand sales, support and engineering operations, according to Independa CEO Kian Saneii, as well as marketing efforts aimed at broadening its customer base. 

The company helps seniors requiring care services to stay at home longer and more safely through the use of technological solutions that can increase comfort and reduce costs of caregiving. 

5. DriveLAB: “Granny Nav” Technology Helps Seniors Stay on the Road Longer

Newcastle University’s Intelligent Transport team is developing technology that supports older drivers and helps them remain on the road longer. The researchers recently converted an electric car into a mobile laboratory dubbed “DriveLAB,” featuring tracking systems, eye trackers, and bio-monitors meant to help researchers understand the challenges older drivers face, and to identify where key stress points are. 

“For many older people, particularly those living alone or in rural areas, driving is essential for maintaining their independence, giving them the freedom to get out and about without having to rely on others,” said Professor Phil Blythe, who led the Newcastle team in investigating in-vehicle technologies for older drivers. “But we all have to accept that as we get older our reactions slow down and this often results in people avoiding any potentially challenging driving conditions and losing confidence in their driving skills. The result is that people stop driving before they really need to.”

The research is part of the Social inclusion through the Digital Economy (SiDE) project, a £12 million research “hub” led by Newcastle University and funded by Research Councils UK’s Digital Economy program. Read more about the research initiative. 

6. RediLearning: Senior Care Personnel Resource for Continuing Education

RediLearning Corp. recently launched an online resource for senior care personnel allowing people to purchase continuing education webcasts, produced in collaboration with the American College of Health Care Administrators. It’s the only place where people can access RediLearning Live and On-Demand webcasts, which feature content offering 1.5 and 2.0 CE credits to long-term care professionals. 

Healthcare real estate investment trust National Health Investors, Inc. (NYSE:NHI) announced on Tuesday it has exercised an option to purchase and lease a new, stabilized skilled nursing facility located in Texas for a purchase price of $13.4 million.

The facility opened at the end of 2010 with 125 beds and is operated by affiliates of Legend Healthcare, LLC. The transaction is expected to close within the next 30 days and will be funded from available cash and from borrowings on NHI’s revolving credit facility.

“This acquisition of a new high quality asset continues the growth and positive diversification of NHI’s portfolio,” said Justin Hutchens, NHI’s president and CEO. 

The REIT reported net income of $18.4 million for the first quarter ended March 31, 2012, down nearly 4% from the previous year. Diluted net income per common share fell to $0.66 from $0.69 in 2011′s first quarter.

Written by Alyssa Gerace

Given that the 55+ housing market represents the “largest growing group of buyers” the National Association of Home Builders has ever seen in that age category, paired with the organization naming multigenerational housing as a top trend in 2012, it remains to be seen how this will be reflected in upcoming construction projects. 

Senior housing is changing, as demonstrated by consumers who want newer, different models of care—either in an age-specific community or in their own homes. And because products are shaped by what consumers want, builders are starting to pay attention to current market demand.

Rising number of multigenerational households

Multigenerational housing is an emerging niche market, at least in certain areas, says Steve Melman, Director of Economic Services at NAHB, adding that the trend is “something to be aware of.” 

As the saying goes, history repeats itself—and so do multigenerational living trends, apparently. By the end of the Great Depression, about 25% of the U.S. population lived in multigenerational households, but 20 years later that number dropped to 15%. By 1980, just 12% of the population lived in multigenerational households.

Right now, the nation is struggling to recover from what’s being called the Great Recession, and the trend is similar: In the past few years, recent figures show multigenerational households surging back up to about 17% of the population, according to Pew Research studies.

“Something’s clearly changing, and there are probably a couple of reasons: the recession is forcing people to move in with each other, or cultural shifts mean some groups are more comfortable having multiple generations living together, aside from economic reasons,” says Melman.

What might multigenerational development look like?

When building a home meant to house more than one generation, there needs to be a different design than for a traditional single-family home. 

One architect says he’s seeing some home developers taking large houses and simply splitting them up by putting in a separate entrance for the “primary” generation and the older parents, but he doesn’t think it’s the best method.

“This feels a little forced, just splitting off a little piece of a home instead of having something specifically built for what it was intended to be,” says Greg Irwin, partner at Orange County, Ca.-based Irwin Partners Architects. 

But he’s also seeing a rise in developers asking about how to incorporate senior accommodations, as multigenerational households increase and put more pressure on the need for intergenerational communities.

Being intentional about designing a home for multiple generations could mean dual master bedroom suites, says Melman, or “in-law” apartments with their own separate functionalities that may increasingly be used to house Grandma. The two master bedrooms could be used for the “primary” homeowner and for a returning college graduate or maybe an aging parent. Alternately, the primary homeowner could choose to have a caregiver (family or professional) move into the second bedroom.

Top trends for 2012

Irwin’s findings are consistent with the National Association of Home Builders’s (NAHB) list of the hottest design trends it expects new home designs will feature in 2012. Released each April, this year’s list pegs multigenerational living as a top trend, along with expanded amenities, reworked spaces, and more cost-effective, impactful designs (homes shaped like rectangles rather than multiple roof lines, etc.).

“Many families are all living under one roof due to increasing cultural diversity and the state of the economy during the past few years,” says NAHB. “New single-family home designs reflect this with “shadow” units that are built alongside a home, or separate living units that access the main floorplan through a door, or homes with at least two master suites—often with one located on the ground floor to be more accessible for elderly occupants.”

Where is the demand?

During a 2007 NAHB survey, a panel was asked if they thought demand for two master bedrooms would increase; 62% said yes. By December 2010, when NAHB again asked that question, expected demand had fallen pretty far down the list, “because at that point it was pretty hard to see the light at the end of the tunnel for the recession,” Melman says. 

“The trend might have been thwarted by the recession, but the demand is still there,” says Melman. What’s happening is that people are having a hard time qualifying for mortgages in general—let alone a larger home meant to house multiple generations. 

NAHB pegs the current 55+ housing market as the largest growing group of buyers the industry has ever seen for this age category, but Melman points to  another age range—a somewhat younger one—as the target audience.

“It’s the trade-up buyers—people who have a first home and are now trading up to a larger home,” he says. “They may be the ones who have elderly parents who might move in, instead of moving them into assisted living, which would be terribly expensive. Having them move in might be a better solution.”

The 55+ buyers, he says, are going to be empty-nesters and many will be looking for a smaller footprint. Young families, on the other hand, generally can’t afford to buy large first homes. Trade-up buyers, in their mid-30s and 40s, he says, “could use that larger home for a variety of reasons, whether its for their growing family, or aging parents.” 

Overall, the market for new construction is slowly, steadily improving—especially for older demographics.

“Consumers are starting to see the resale market show some improvement, which allows them to start thinking about moving into 55+ housing,” said NAHB Chief Economist David Crowe. 

Written by Alyssa Gerace

Given that the 55+ housing market represents the “largest growing group of buyers” the National Association of Home Builders has ever seen in that age category, paired with the organization naming multigenerational housing as a top trend in 2012, it remains to be seen how this will be reflected in upcoming construction projects. 

Senior housing is changing, as demonstrated by consumers who want newer, different models of care—either in an age-specific community or in their own homes. And because products are shaped by what consumers want, builders are starting to pay attention to current market demand.

Rising number of multigenerational households

Multigenerational housing is an emerging niche market, at least in certain areas, says Steve Melman, Director of Economic Services at NAHB, adding that the trend is “something to be aware of.” 

As the saying goes, history repeats itself—and so do multigenerational living trends, apparently. By the end of the Great Depression, about 25% of the U.S. population lived in multigenerational households, but 20 years later that number dropped to 15%. By 1980, just 12% of the population lived in multigenerational households.

Right now, the nation is struggling to recover from what’s being called the Great Recession, and the trend is similar: In the past few years, recent figures show multigenerational households surging back up to about 17% of the population, according to Pew Research studies.

“Something’s clearly changing, and there are probably a couple of reasons: the recession is forcing people to move in with each other, or cultural shifts mean some groups are more comfortable having multiple generations living together, aside from economic reasons,” says Melman.

What might multigenerational development look like?

When building a home meant to house more than one generation, there needs to be a different design than for a traditional single-family home. 

One architect says he’s seeing some home developers taking large houses and simply splitting them up by putting in a separate entrance for the “primary” generation and the older parents, but he doesn’t think it’s the best method.

“This feels a little forced, just splitting off a little piece of a home instead of having something specifically built for what it was intended to be,” says Greg Irwin, partner at Orange County, Ca.-based Irwin Partners Architects. 

But he’s also seeing a rise in developers asking about how to incorporate senior accommodations, as multigenerational households increase and put more pressure on the need for intergenerational communities.

Being intentional about designing a home for multiple generations could mean dual master bedroom suites, says Melman, or “in-law” apartments with their own separate functionalities that may increasingly be used to house Grandma. The two master bedrooms could be used for the “primary” homeowner and for a returning college graduate or maybe an aging parent. Alternately, the primary homeowner could choose to have a caregiver (family or professional) move into the second bedroom.

Top trends for 2012

Irwin’s findings are consistent with the National Association of Home Builders’s (NAHB) list of the hottest design trends it expects new home designs will feature in 2012. Released each April, this year’s list pegs multigenerational living as a top trend, along with expanded amenities, reworked spaces, and more cost-effective, impactful designs (homes shaped like rectangles rather than multiple roof lines, etc.).

“Many families are all living under one roof due to increasing cultural diversity and the state of the economy during the past few years,” says NAHB. “New single-family home designs reflect this with “shadow” units that are built alongside a home, or separate living units that access the main floorplan through a door, or homes with at least two master suites—often with one located on the ground floor to be more accessible for elderly occupants.”

Where is the demand?

During a 2007 NAHB survey, a panel was asked if they thought demand for two master bedrooms would increase; 62% said yes. By December 2010, when NAHB again asked that question, expected demand had fallen pretty far down the list, “because at that point it was pretty hard to see the light at the end of the tunnel for the recession,” Melman says. 

“The trend might have been thwarted by the recession, but the demand is still there,” says Melman. What’s happening is that people are having a hard time qualifying for mortgages in general—let alone a larger home meant to house multiple generations. 

NAHB pegs the current 55+ housing market as the largest growing group of buyers the industry has ever seen for this age category, but Melman points to  another age range—a somewhat younger one—as the target audience.

“It’s the trade-up buyers—people who have a first home and are now trading up to a larger home,” he says. “They may be the ones who have elderly parents who might move in, instead of moving them into assisted living, which would be terribly expensive. Having them move in might be a better solution.”

The 55+ buyers, he says, are going to be empty-nesters and many will be looking for a smaller footprint. Young families, on the other hand, generally can’t afford to buy large first homes. Trade-up buyers, in their mid-30s and 40s, he says, “could use that larger home for a variety of reasons, whether its for their growing family, or aging parents.” 

Overall, the market for new construction is slowly, steadily improving—especially for older demographics.

“Consumers are starting to see the resale market show some improvement, which allows them to start thinking about moving into 55+ housing,” said NAHB Chief Economist David Crowe. 

Written by Alyssa Gerace

It’s not uncommon for people to negotiate prices for flea market finds, cars, or even houses, but one area where most people don’t think to bargain is retirement residences—and they should, reports the Wall Street Journal.

Especially at continuing care retirement communities (CCRCs)—most of which charge entrance fees—incoming residents could save a bundle, like a Pennsylvania woman who was able to shave 35% off her upfront costs of moving into one such community.

Dickering can pay off. “Active adult” developments often charge steep monthly fees for amenities, and CCRCs generally require a hefty deposit, along with monthly fees for care ranging from independent living to round-the-clock nursing.

The average entrance fee for a CCRC unit is $259,000, according to the National Investment Center for the Seniors Housing and Care Industry, a research and data group in Annapolis, Md.

But the real-estate downturn, which made it tougher for older adults to unload their houses, in turn wiped out waiting lists at many popular retirement communities, giving retirees who are ready to move in more leverage, experts say.

Such communities need to stay full to fund their general operations, build reserves and help finance refunds. The community where Mrs. Nerenberg plans to move, for example, refunds 90% of the entry deposit after the resident dies. And monthly fees paid by residents in independent-living units generally help support the higher costs of those who have moved to assisted-living or skilled-nursing arrangements.

Haggling prices for retirement homes is a trend that’s still “in its early stages,” but some financial planners are helping their clients evaluate their retirement living options and costs. 

Read the full Wall Street Journal article. 

Written by Alyssa Gerace 

Pharmaceutical company Omnicare, Inc. (NYSE:OCR), the nation’s largest pharmacy for long-term care facilities, must pay the U.S. government $50 million in a settlement over complaints it dispensed painkillers to nursing homes and other senior care facilities across the country without proper prescriptions or authorization.

The Covington, Ky.-based company’s settlement with the Department of Justice is the second-largest civil settlement in history of the Controlled Substances Act, and follows a Drug Enforcement Administration investigation of “alleged errors and deficiencies” in how certain Omnicare pharmacies distributed controlled substances.

“While DEA regulations specifically address retail and hospital pharmacy operations, long-term pharmacies have historically operated in a less defined middle ground, dispensing controlled substances on instructions from long-term care facility staff after the staff’s consultation with the ordering authorized prescriber,” said Omnicare in a statement about the settlement. “This civil settlement makes it clear that DEA interprets its regulations to require the ordering authorized prescriber to either sign an order containing all of the elements of a valid prescription prior to dispensing, or in limited emergency circumstances for Schedule II controlled substances to speak directly with the pharmacy prior to dispensing.”

Omnicare’s CEO, John Figueroa, said the pharmaceutical company “understands and accepts” the DEA’s efforts to make sure appropriate procedures are followed when distributing drugs. “While requiring authorized prescribers to communicate directly with the pharmacy can potentially cause delay, we have committed ourselves to shortening the time in which nursing home residents receive required medication,” he said. 

As part of the settlement, Omnicare has agreed to make the payment within the next few days in exchange for being able to continue dispensing medication.

The company has developed an electronic prescribing application for controlled substances for the institutional market which is expected to improve patients’ quality of care while adhering to DEA regulatory interpretations; it also transmits electronic prescription orders for other non-controlled drugs.

Written by Alyssa Gerace 

As assisted living regulations evolve and tighten, Medicare and Medicaid reimbursements fluctuate, and healthcare reform begins to take effect, many states are facing their own challenges as they continue to develop, operate, and implement new rules and programs. Here is a collection of long-term care related stories from across the nation that are worth reading.

From the Sun Sentinel (Florida)—Assisted Living Evictions Have Few Rules in Florida

“Assisted living facilities often market themselves as “just like home,” cozy places where people will live just like they did in their houses or condos. But many don’t realize their new lifestyle has the equivalent of a month-to-month lease,” reports the Sun Sentinel. “Under Florida regulations, assisted living operators need give residents little more than a 45-day written notice in order to evict them. The discharge rules are among the least restrictive in the nation, according to the National Senior Citizens Law Center.” Read more…

From Enterprise News (Massachusetts)—Battle Looming at Statehouse Over Nursing Home ‘Bed  Holds’

“Senior advocates are calling on state lawmakers to preserve a program that allows nursing home residents to keep their rooms after brief absences, such as hospitalizations,” reports Enterprise News. “Bed holds were the center of a funding battle last year, when Patrick vetoed $6 million for the program from a supplemental budget. Defying the governor, lawmakers put the money back into a final version of the budget and Patrick ultimately signed it in the fall. Without the bed hold program, the [nursing] home receives nothing, giving some little choice but to fill a bed with another patient in order to keep funding operations, said [W. Scott Plumb, senior vice president of the Massachusetts Senior Care Association].” Read more…

From the Health Care Council of Illinois—Nursing Home Supporters Rally in Chicago to Fight Medicaid Cuts

Pending cuts to Illinois’ Medicaid system would costs thousands of jobs and threaten care at nursing homes across the state, according to nursing home administrators, health care leaders and elected officials who rallied at the Thompson Center in Chicago on Monday in an event organized by the Health Care Council of Illinois (HCCI), which represents more than 500 nursing homes and rehabilitation facilities across the state of Illinois. “Legislators are considering Governor Quinn’s proposal to slash Medicaid spending by $2.7 billion. The proposed cuts to nursing homes could drastically jeopardize the quality of care for the more than 50,000 people residing in Illinois nursing homes who pay with Medicaid,” says HCCI. “These cuts put nursing homes at risk for closing, especially some Chicago nursing homes where Medicaid recipients make up more than 90 percent of the resident population.” Find out more…

From Mainline Media News—Pa. Gets First Look at Voter IDs for Nursing Home Residents

“Pennsylvania Secretary of State Carole Aichele came to Rosemont Presbyterian Village Friday to tout the state’s efforts to get approved identification for residents of retirement and nursing centers for voting in November. Aichele appeared with Radnor State Rep. William Adolph to answer questions about the new law. At the meeting Aichele unveiled a new identification paper, provided by the care facility, which is acceptable for voting,” reports Mainline Media News. “Aichele said that the identifications would be provided by the health-care facilities. The ID will include the name of the facility, the picture, the person’s name and an expiration date. The nursing home then needs to send the Department of State a copy of names on the IDs.” Read more…

Assisted Living Today Ranks Top 20 Massachusetts Assisted Living Facilities

The list of senior care facilities—which was compiled by the research staff at Assisted Living Today—features 20 of Massachusetts’ finest assisted living facilities that were evaluated on a range of factors, including operational excellence, quality of the residences, range of amenities and access to 24-hour care, among others. View the list.

From News and Sentinel—Ohio Program Helps Seniors Age at Home

“While nursing and rehabilitation facilities may be the right option for some people, programs like the Housing Assistance Grant Program through the Area Agency on Aging 8 aim to help seniors “age in place,” since remaining in one’s home can be beneficial to seniors—and the state’s coffers,” reports the News and Sentinel. “A year in an Ohio nursing home costs an average of $60,000 for someone covered by state Medicaid funds, according to figures from the Area Agency on Aging 8. Even people who start out spending their own money could wind up being supported by public dollars once their assets are depleted. Meanwhile, the annual care plan for [one Ohio resident] who is covered by the Medicaid-funded PASSPORT program, costs $8,497.” Read more…

From the Missourian—Veterans’ Nursing Home Funding Bill Sent to Missouri Governor

“Missouri lawmakers have sent the governor a measure providing a dedicated funding source to veterans’ nursing homes,” reports the Missourian. “The bill given final approval Thursday by the House would earmark most of the state’s fees from casinos to a trust fund for the Missouri Veterans Commission. The intent is to provide a permanent, predictable funding stream for the state’s seven nursing homes that serve more than 1,300 military veterans.” Read more…

Third time wasn’t a charm for Covington Investments, LLC, who has sent three rejected proposals to acquire Brentwood, Tenn.-based skilled nursing operator Advocat Inc. (NASDAQ:AVCA)—the latest for $8.50 a share (approximately $51 million). 

“In letters on February 27, March 22, and April 12, 2012, we made what we believe to be very compelling proposals to acquire Advocat in a transaction that would provide substantial value to your shareholders,” wrote John McMullan, the president Covington Investments, in a letter to Advocat’s board of directors, dated May 11. “We were surprised and disappointed that Advocat’s Board of Directors has shown no interest in a discussion to explore our acquisition proposal.” 

Covington believes Advocat’s shareholders “would want and expect” its board to “explore” the possibility of the transaction, and after the lack of response, the investment company has decided to make its proposal public “in order to inform Advocat’s shareholders of the significant value they could receive in a transaction with Covington.” 

The proposal values the skilled nursing facility operator at $8.50 per share, for an approximate $51 million (or $44 million, excluding the 12% of shares Covington’s affiliates already own).

The price increased from the $7.50 per share offered in the Feb. 27 letter, after Advocat’s board indicated the price “was not sufficient to discuss a combination,” said McMullan in the letter. 

Now that they’ve upped the price, Covington says their offer “represents an extraordinary value” to the operator’s shareholders, as the price represents a 96% premium above May 10′s closing price of $4.34, a 71% premium above the average closing share price in the past 30 days, and a 55% premium above the average closing share price in the last 90 days. 

And, McMullan points out, the last time Advocat’s shares closed above $8.50 was in November 2009.

“We do not understand how the Board’s unwillingness to even discuss our Proposal in favor of an uncertain and questionable standalone strategy can serve the best interests of Advocat’s shareholders,” said McMullan in the letter. “In light of Advocat’s financial performance, as evidenced most recently in its first quarter earnings release on May 9, 2012, we are even more puzzled by the Board’s refusal to entertain our Proposal.”

Advocat reported a $1.54 million net loss attributable to shareholders in the first quarter ended March 31, 2011, attributed to Medicare reimbursement cuts and rising costs of facility staffing, marketing, and support areas resulting from “strategic initiatives,” according to Kelly Gill, the company’s CEO.

“We remain focused on the implementation of our growth strategy, which centers on enhancing our high acuity patient care services, modernizing our facilities, and prudently expanding our facility portfolio,” said Gill in the first quarter earnings report. “We are seeing benefits from these efforts in terms of improved skilled census, our capabilities to market to and care for higher acuity patients and, as a result of the implementation of electronic medical records, the ability to better document the high quality services we have always provided.” 

Following Covington’s public acquisition proposal announcement, Advocat shares surged over 70% on the NASDAQ to $7.39.

Advocat did not respond to SHN’s request for comment as of press time. 

Click here to view McMullan’s letter to Advocat shareholders.

Written by Alyssa Gerace 

With technological advancements tied so closely to the future of senior care, Senior Housing News recently interviewed Majd Alwan, Ph.D., the Senior Vice President of Technology and Executive Director of the Center for Aging Services Technologies (CAST) at LeadingAge, an association of not-for-profit, long-term care providers of senior services.

At any given time, CAST is involved in multiple projects, ranging from conducting research and writing reports on available technological solutions and their impacts on senior living providers’ business and financial models, creating a reward-based competition recognizing pioneers in technology-enabled services and support, and advocating for the inclusion of long-term post acute care (LTPAC) providers into federal initiatives.

Senior Housing News: What’s LeadingAge/CAST doing in terms of senior care technology development and implementation?

Majd Alwan: Our mission is to accelerate the development, evaluation, and adoption of appropriate technologies by long-term and post-acute care providers to improve the quality of care and life for seniors, reduce the burden of care on providers, and reduce healthcare costs without compromising quality. Our mission is to change the aging experience through technology, but we don’t necessarily develop technology.

CAST brings developers—big ones like GE, all the way to small start-ups—together with forward thinking and pioneering service providers who understand the value of technology and are exploring technology-enabled care models and implementing them in their communities, and researchers. These three coming together under the umbrella of CAST to accelerate the adoption and development.

We do research to create awareness of available solutions. We’re conducting a study for the Department of Health and Human Services looking at evidence of the cost-effectiveness and experience of other countries with aging services technology, and the barrier to the development and adoption of these technologies, which we’re expecting to wrap up by April.

SHN: A study about mobile health technology was recently released that included a report on some countries who have run pilot programs implementing remote monitoring of seniors. Do you think this will catch on in the U.S.? Who’s already doing it, and doing it well?

MA: Absolutely. Remote patient monitoring, or telehealth—whether using mobile devices or using home-based telemonitoring technology—has significant potential. The most successful example is the example of the Veteran’s Administration. They have the largest telehealth program in the U.S., and they’ve demonstrated impressive improvements in outcome and impressive cost-savings.

The technology basically uses remote patient monitoring, but rather than giving each older adult a mobile internet device, or deploying a telehealth station in their home, it’s easier to use a telehealth kiosk deployed in natural congregation areas. This is a lot more cost-effective mechanism to manage chronic conditions than individualized-based solutions.

Many or our members are looking at deploying kiosks in senior housing, retirement communities, assisted living, etc. There are several examples in LeadingAge’s Preparing for the Future report (an aging services technology study), including Jewish Home Lifecare. One of the chapters of our study is on the management of chronic conditions.

SHN: What’s your sense of providers’ attitudes toward technology within LeadingAge?

MA: There are over 1,500 aging health providers who belong to LeadingAge, and each has its own set of priorities and challenges. The report “Preparing for the Future” highlighted 18 case studies, and these are only a sample of LeadingAge members who are exploring or implementing technology.

It’s a care model that is likely to emerge or become more mainstream in the near future, given the current challenges we have, and the limitations on funding streams and current reimbursement systems, which is unsustainable.

You also have providers who are stuck with legacy systems, legacy payment or reimbursement systems.

Some of providers get some reimbursement for telehealth, remote monitoring, etc. They’re forming strategic partnerships with hospitals, for the management and stabilization of conditions of newly-discharged patients so they don’t experience a readmit, enabling the hospital to avoid a readmission penalty.

It’s similar principle to Accountable Care Organizations, but not the same, because only select organizations become ACOs, whereas penalties for hospital readmissions are going to apply to all hospitals whether they choose to become an ACO or not.

SHN: How have providers’ outlooks changed in the past few years?

MA: The adoption of technology is on the rise, on the increase, especially with respect to Electronic Health Records (EHRs) and telehealth technology. This is a direct effect or result of the significant federal investment in the national Health Information Technology (HIT) infrastructure and CMS incentives program, even though this incentive program and the vast majority of the federal HIT initiative have been aimed primarily at hospitals and physicians, and not at LTPAC, per se.

But this has shown the importance of having EHRs in LTPAC to improve, for example, the likelihood of getting referrals from hospitals. Especially within the long-term care, not-for-profit sector, we see higher adoption of EHRs, potentially because of the impact that these providers see directly on the quality of care, and the quality of their ability to better coordinate care with their healthcare partner system. It’s a direct impact they see in their residents, and it’s aligned with their mission, despite the fact that there is no financial incentive.

SHN: Who is investing in senior care technology?

MA: There are several technology companies who are investing in or making significant investments, including Intel and GE. And it’s not only funded research; for example, Ireland’s Technology Research for Independent Living, cofunded by the Irish government, is jointly invested in creating joint venture with Intel/GE Care innovations.

Phillips is continually investing in technology;  private equity firms are providing venture capital; venture firms are also providing capital in this space.And, of course, you have the federal government primarily investing in the national HIT infrastructure, and also through several research programs, including the National Institute on Aging.

There are also private foundations, such as the Helmsley foundation, which gave an $8.1 million grant to the Evangelical Lutheran Good Samaritan Society to help find ways to keep seniors out of nursing homes.

SHN: What influence is technology going to have on policy regarding staffing/patient ratios at a state and national level within the next 18-24 months? In the next five years?

MA: There are regulations in place right now regarding these ratios. As these models are still emerging, as they mature, there may or may not be a need to revisit those regulations.

There was a study that showed that behavioral monitoring improves efficiency of care staff at assisted living, and reduces the burdens of care, but this was a small scale demonstration. Once it’s done in a larger scale, and there’s a better sense of the kind of efficiencies the monitoring could produce, it might be a better time to pose these questions. For right now, it’s too soon.

SHN: Is technology the silver bullet for staffing issues in senior care?

MA: It’s not going to be the silver bullet, no. I believe that technology could be an efficiency tool. It could significantly improve, after the first few months, the learning curve… it definitely can improve or help with the shortage of caregivers.

For examples, with telehealth—with mobile or home-based devices, you can have a nurse sitting in a call center manage up to 200 patients with chronic conditions such as diabetes, congestive heart failure, or hypertension, without those patients having to get behind the wheel and drive somewhere.

It’s the same with monitoring activities of daily living. Potentially, based on monitoring activity levels, sleep patterns, and deviations, you can identify potential health issues.

Early detection and better management mechanisms would reduce the workloads on healthcare professionals and would also improve the efficiencies of these healthcare professionals.

Similarly with EHRs, there’s an the ability to share this information among providers, and they’ll have the ability to reduce unnecessary procedures. But it’s not going to be a silver bullet.

I believe that if we adopt technology in the long-term and post acute care industry, we would probably be able to attract additional, new talent to become front-line staff, as well.

Builders have tremendous opportunity in the 55+ housing market, which is currently the “largest growing group of buyers…ever seen” in that age category, according to the National Association of Home Builders.

While builder confidence surveys indicate that no sectors in the 55+ housing market are performing “well,” per se, all are on an upward trend, and multifamily rental housing continues to lead the way, according to NAHB’s first quarter 55+ Housing Market Index, released on Thursday. 

The overall 55+ Housing Market Index increased 10 points to 27 in the first quarter. “Although 27 is relatively low for an index that lies on a scale of 0 to 100, it is nevertheless the highest reading since the inception of the index in 2008,” says NAHB. 

“We continue to see increased optimism from builders and developers in the 55+ housing segment,” said NAHB 50+ Housing Council Chairman W. Don Whyte in a statement. “We are servicing the largest growing group of buyers that we have ever seen in this age category, and it is a population that is dramatically different from what it was only a few years ago. This creates an opportunity for builders and developers in this market to create communities that address the specific needs of the 55+ consumer.”

The single-family market for this age category saw all components below 50 (meaning more builders view conditions as poor than as good), but it reached an all-time high in the first quarter, with present sales rising 12 points to 27; expected sales (for the next six months) rising eight points to 32; and traffic of prospective buyers rising nine points to 26.

Multifamily rentals in the 55+ market leads the way in builder confidence, climbing 11 points to 31. Expected future production increased eight points to 35, while current demand for existing units rose three points to 42, and expected future demand increased slightly to 45 points. 

The 55+ multifamily condo index didn’t fare as well and remains the weakest out of all the 55+ indices, according to NAHB. However, it reached an all-time high at 15, up seven points from last year, and all index components rose in the first quarter compared to 2011. Present sales rose five points to 14; expected sales (for the next six months) rose seven points to 20, and traffic of prospective buyers jumped nine points to 15.

Just like the overall single-family housing market, the 55+ segment is experiencing a “slow but steady recovery,” according to NAHB Chief Economist David Crowe. “Consumers are starting to see the resale market show some improvement, which allows them to start thinking about moving into 55+ housing.”

Written by Alyssa Gerace

For many, finding the right place for an aging family member to live is the single-most important aspect of choosing a senior living or care community, but especially in this economy, that’s followed closely by figuring out how they will pay for that care. Life Care Funding Group and LivingSenior have launched a strategic partnership to address both of these needs, with a goal of providing education and access to seniors and their families about where to go, and tools to help pay for the costs.

LivingSenior’s database of independent and assisted living communities, nursing homes, memory care, and home health providers is teaming up with Life Care Funding’s financial information and resources to help pay for these services for a “one-stop” solution, the companies say.

Life Care Funding helps educate families about private pay funding options and access to programs such as converting life insurance policies into long-term care “Assurance Benefit” plans, the Veteran’s Aide & Attendance Pension, and other financial solutions. 

“We believe strongly it isn’t enough to just provide families with information about how to access senior living and long term care providers,” said Daniel Dormer, Co-Founder of LivingSenior. “But they also need to understand their options to pay for care– or else how will they be able to afford it?”

Written by Alyssa Gerace

Being a senior housing manager is the core of what Sunrise Senior Living (NYSE:SRZ) does, but the company is also opportunistic in terms of buying real estate in advantageous situations, said its CEO Mark Ordan during the company’s first quarter earnings call. 

“We understand the capital markets, we understand the real estate market, so if there is an opportunity for us to buy real estate in an advantageous way we will do it,” he said. “Similarly, if we think that there is value in our real estate that would be better off with us not owning it and somebody else owning it, that’s fine as well.”

Sunrise used to own a portion of the Ventas (NYSE:VTR) portfolio, Ordan pointed out, but sold it back to the REIT a couple years ago. Since then, his company’s metrics have “only improved.” 

“So, we don’t think that we need to own real estate to maximize the performance of those assets,” he said. “We will do it whether we are manager or we are an owner. We want to make sure that whatever we are doing, we are maximizing value and if that’s buying real estate we will buy it; and if it’s selling real estate, we will sell it.”

On ancillary services:

Sunrise is working toward enabling each of its 320 communities, many of which are owned by the operating company, to have the right to purchase and operate the community at “maximum efficiency” while providing the best care, Ordan said. He also mentioned the company’s efforts to pilot “terrific new programs” for memory care, to maintain its spot as the nation’s largest provider of memory care services. 

“The next obvious step is to say, ‘Well, what other services can we provide to our residents?’” Ordan said during the earnings call, adding that’s something they’ve been working on. “We want to make sure that when we do that, we do it properly and carefully, so that we don’t have a hiccup. So that is something that we foresee adding to what we do.”

As far as ancillary services go, Ordan said he thinks there are “great opportunities” for new service lines, but added that his company wants to keep a strong focus on its core offerings. However, “we still see significant additional opportunity running our business the way we do, just doing it better.”

Read the full earnings call transcript.

Written by Alyssa Gerace