PBS shines a bright light on Assisted Living – will change follow?

By now, you’ve probably heard about or seen it.  PBS’ Frontline and ProPublica spent a year researching care, life and wrongful deaths in the largest of assisted living companies, Emeritus Senior Living. After the broadcast, some honest self-examination, but also those expected positioning statements and self-righteous comments emerged from Emeritus, industry observers, plus defensive responses from the industry lobbying leaders – ALFA and Leading Age. Larry Minnix (Leading Age) tells ALF executives to ask themselves, “What are your staffing levels?” Indeed. And we should ask as well. What should they be in an AL memory unit? He doesn’t say. Read the Frontline attached interview with a regulatory agency CEO -- and how variations across state boundaries can be justified. Really. So shouldn't facilities be shut down after horrible incidents like these? Remember the Miami Herald series Neglected to Death? Not just one company (as in the Frontline story) but many organizations, large and small, throughout Florida, not just one incident but multiple. As with many incidents, company growth may slow a bit, organizations may consolidate under new ownership or new names, but rarely are they shut down.

What’s in a name?  The term Assisted Living sets an expectation.  The moniker 'Assisted Living' implies but does not really specify a level of care.  Designs and décor amplify this comforting impressionism – and industry articles champion quality. The PBS documentary would have you believe that Emeritus is more profit- and real estate-focused, more aggressive at marketing and more likely to fire whistle blower employees. But really, are they so unique in accepting residents who supposedly are too frail to meet the industry’s vague differentiation from nursing homes? Really, is Emeritus the only company that has inadequate dementia care staff training; are they the only ones who have too few staffers for the number and acuity of residents? After all, the most profitable service in assisted living today is memory care – averaging $57K per year, a 42% price hike over average assisted living prices.  Perhaps you’ve visited memory care units. Do you look around and see that 42% price/services differential beyond the locked door?

Other industries see expectation management as critical.  Maintaining profit in a labor-intensive service industry – for example, hospitality – must meet expectations by having enough staff, pay, and supervision to serve guests. If you found dirty linens when checking into a hotel or encountered rude staff, you’d squawk; next time you’d warn others and pen a review on TripAdvisor. But if we see our mother or father’s dirty bathroom or we observe residents who are unkempt, at first we try not to notice -- it undermines our faith that we made the right choice. But each time we visit and see a problem, our optimism dwindles as our reluctance deepens to  avoid moving a family member yet again. And the Internet is not helpful. There are no well-populated review sites for assisted living. For example, OurParents.com and Caring.com have a few reviews of this Florida Emeritus facility -- but no link to the widely publicized news story about the resident who took off his Project Lifesaver bracelet, wandered away and was never found.

What would you want for yourself? We repeat our desire to age at home, but some of us are going to need some type of assisted living. Maybe dementia or some other condition will make it seem like a reasonable choice. Maybe we will feel safer than in our danger-laden houses located in deserted areas or with a solitary home care worker. Perhaps we will be able to afford the no-holds-barred price because we were lucky and sold an expensive property, or perhaps we managed our finances well. We put it off, but now we’ve moved in.  What is different from the news makers of 2013? Will it be remote monitoring technology?  Redesigned layouts maintaining sight lines for staff?  Silent alert door warning systems? Or will it be well-marketed high staffing ratios, low staff turnover, experienced executives, engaged nursing oversight, staff-and-family training programs, vocal family councils and well-established volunteer programs that maximize observation opportunity -- plus service and activity personalization that will match our family’s high expectations and optimism about care? Although the profit margin may suffer, the definition of quality will be well understood; online reviews will be widely available with many comments – feedback will be encouraged and responses from management will be expected.  And whether it is Kansas or Kentucky, even consumers will know what to expect.
 

 

 

Online Reviews

Hi Laurie, thanks for sharing your thoughts on the PBS Frontline expose. Part of our mission at SeniorAdvisor.com is to help raise the level of care in the industry, as well as encourage dialogue between community managers and the residents and families they serve. We believe online reviews of senior communities can be a great resource to families during their search for senior care, and can help people feel more confident in the decision making process.

An Interview with AC Thompson -- and commentary

This entire thread on Senior Housing Forum is worth a follow-up read.

http://seniorhousingforum.net/blog/2013/08/13/ac/

Excellent comment from LinkedIn about what ALFs should do

This is a wake up call for senior living communities to change their infrastructure and model of care. It is time to adopt a preventative approach that offers older adults an opportunity to maintain or improve their functional fitness and independence. The focus has been on "skilled nursing", which promotes the "illness" model of care. It is time for AL to provide quality functional fitness by a certified senior fitness instructor, providing the foundation for wellness. How many residents do you know who improve their ADL functional abilities once they move into an AL community? That can happen when quality fitness programming, wellness based activities and purposeful living becomes the priority in a community. I know this from personal experience.

Why do senior living communities have entertainment budgets, but not fitness budgets? Why do they continue to offer passive activities like Bingo and entertainers, rather than quality brain fitness programs and clubs that evolve based on the interests of the residents (gardening, life journaling classes, quilting, woodworking, painting, wreath or jewelry making etc.). Where are the opportunities for our older adults to remain engaged in life by finding meaningful ways to share their wisdom, values and to contribute to society? Why aren't senior living communities promoting intergenerational opportunities ( and I don't mean once a month preschool or middle school visitations to play games with residents)? What about opportunities to volunteer to tutor young children or get involved in community projects, recycling etc. Sedentary lifestyle leads to physical and mental decline. That is a fact. But what choice do families have when the standard "illness" model is all that is available for their aging loved ones? It's time for change! Aging Baby Boomers are doing all that they can to stay out of senior living communities,because they don't buy into the present "model of care". Boomers choose to age in place and my guess is that this could be an impetus for local government and agencies to partner with fitness and wellness businesses to develop the necessary support systems to allow Boomers to do just that!

Another concern I have is that senior living communities are scrambling to come up with innovative ways to deal with persons who have dementia and they are overlooking the benefits of quality exercise which is the number one pillar of brain health! Why not offer early stage dementia residents exercise as medicine? Yes, this is a long overdue wake up call! Now what are we going to do to make it better? If you are on the same page, I'd love to hear from you.

Cheryl  Bartholomew

http://www.seniorsnsync.com/

Changes in "Assisted Living..."

Thanks Laurie,

A much needed retrospect of the current "crisis" in long term care. Better forethought and education on where families place their loved-ones is needed as well as good communication from the provider to family members is essential. New technology is not the answer...just the ability to provide better care using current technologies.

Although Emeritus was targeted in this report the problem exists throughout the industry. Families need to be overly cognitive of the the care they will require of their loved ones and hold them, the provider, to the fire for timely updates, reporting and most important...simple communication.

Suitability of ALF

As a health professional with more 25 years consulting experience to both SNFs and ALFs, I was quite surprised when I was asked to review the medications of a g-tube resident recently admitted to an ALF. I was told an outside agency had been contracted for care and administration. My biggest question was why would the family put their loved one in an assisted living building and not a nursing home. One answer is the stigma that still exists of putting a loved one in a "Nursing Home." Emotionally, a nursing home means we failed to take care of mom. Now she lives in an institution where she will wither and die and it's all our fault. ALFs have become the antithesis of SNFs, beautiful surroundings, beautiful rooms, great cuisine. And that's why most families accept the inevitable breakdowns in facility care, because their mom is not in a nursing home. There is much less guilt.

The answer? Certainly requiring similar regulatory standards to SNFs is a start, along with strict, enforceable guidelines on eligibility to ALFs. But one additional important factor is for the family to be able to objectively assess the needs of their loved ones before placement. Understand what ADLs are, understand what a mini mental state exam is (MMSE). Talk to professionals who understand them as well. By totally understanding the acuity level of your loved one can you make a more informed decision about their future care.

Where will change come from...

Laurie...I love your analogy of hotels and TripAdvisor.

I truly believe the only way we will see advancement in elder care is to re-evaluate the need from the beginning and start searching for new solutions beyond what is available today, particularly in the Assisted Living space. Trying to fix existing industries(like Assisted Living) or companies(like Emeritus) is not going to work. It is so hard for an incumbent or existing company to do anything beyond incremental changes. They have "drank the Kool-Aid". This is true in all industries.

I don't think there is a silver bullet either. This is a complex space. On one hand, Wall Street has its eye on just the short-term and rewards for short-term, but investors themselves could be voting with their own purchases and vote for companies that are doing the right things. Until we have more transparency (a TripAdvisor), we will not see more companies doing the right things. Wall Street is really hurting the economy at the moment, but slowing I'm beginning to feel investors are rewarding companies for doing the right thing, not just for the almighty dollar.

Culturally we also seem to have many different mindsets around the world to address these issues. Here in the U.S. we need to get families to address these issues sooner rather than waiting for a crisis, which is what happens today.

I have always enjoyed your perspectives and candor on this blog...keep it up!

The Model is Flawed

In the 1980's, I worked in and completed my dissertation in the first assisted living facility in the country. My research showed that within six months of move-in, most residents declined significantly and needed more care than expected. State aging service policy makers admitted, during interviews, that staffing was not sufficient to provide care unless residents remained quite healthy and independent. I even had a resident ask me if she could move somewhere where there was more attention from staff. She was afraid and felt completely isolated. Administration told me this was "crazy" and to keep filling the beds. So, from the beginning the model was flawed.

Let's face it, families and older adults do not make this move until absolutely needed, a result of an injury, illness or other crises. Residents are frail at move-in, may be in decline, and the move itself is another stress. Fast forward to today, when the age at move in is even older and residents in need of more care. Yet, 25 years later we still do not have policies requiring adequately trained staff and a adequate numbered of staff. I have a hard time explaining this lag in policy response to my graduate level gerontology students.

While I agree, Laurie, that technology could be better used to improve safety, and involved families and staff can enhance care, we must revisit this model. Twenty-five years is too long for a more creative approach.

PBS shines a bright light on Assisted Living – will change follo

I've spoken with CNAs that work in ALF. They are required in most cases to care for 10 or more persons. All have said that caring for so many is impossible. ALF make no bones about the fact that they are just running a hotel type facility. Since that is the case, workers at ALF, inmates (yes it is a good word to use), and family members who interact with the inmates should establish a site like Trip Advisor. The only way the ALF industry can profit is by reducing either facility maintenance costs and/or labor costs. Given that Wall Street (and the CEOs themselves) want increased profits each year to justify CEO outrageous salaries and stock prices, the For profit ALF have few ways to increase profits. The continued decline in the number of Nursing Home providers points to that fact. I think that Boomers have already seen those issues with ALF for their parents and will not follow that path. Aging in the Home will be the default with services brought into the house. In many case, this is the financial savvy way to go since the person gets one on one care, can be directly hired, and can be paid more than the $8-$9 typically paid to CNAs. I've seen this model work well in a number of cases. As one CNA told me, I get paid well by not having an agency rake off half of what they charge to find a caregiver. I personally think that this will become the default way for the Boomers.

Time to put a new show on the road

This story is only the top of the iceberg. We all are responsible for creating such poor and unacceptable long-term care working and living conditions. It is really time for us to wake up and put a new show on the road.

All of us are responsible to tolerating such bad management and living conditions. We can begin by admitting the seriousness of the problem and do something about it like adopt the Caregiver Partnership Agreement Program to add workers without increasing the bottom line. Then we can train staff properly with including an Alzheimer's and Dementia Certified management position: http://www.remembering4you.com/alzheimers-coaching-program-philosophy/ in every facility such as assisted living (like in this story), nursing centers, hospitals, etc.

We have to admit there is a problem before we can fix it. We also have to have the courage to bring the necessary changes and expose the greed of some larger corporations who are reaping millions from everyone of us. We also have to hold government officials at both the federal and state levels for being willing partners in these atrocities. Those officials have to be exposed for what they know and what they secretly cover up.

Sincerely,
Dr. Ethelle Lord
Remembering4You (dot) com
Pioneer in Alzheimer's Coaching

From Sandra Borr - Facebook

The program raised awareness of issues. The fact is that the largest number of people this country has birthed in one generation; the "Love is All You Need" generation, is aging and our economy may never rebound.

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