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.
When the 911 call may be necessary but not sufficient. The news about the no-CPR policy in an independent living community in California brought me back. In the incident reported everywhere, the nurse claimed that the policy in independent living did not include providing CPR – and as a result, the elderly woman died. Years ago when my mother spent some time in an assisted living facility, 911 was invoked nine times within a single year before they ejected her to a nearby nursing home, claiming they could not provide care. Each of her ER visits involved either my sister or me – racing to the ER from work so that we could explain her history – one time we stopped a dose of Bactrim that she was allergic to – another time we interrupted her inaccurate description of her medical history cheerfully being offered to an intern who had not checked her chart and apparently did not know she had dementia.
Does rising cost parallel consumer distaste for long-term care? Perhaps this caught your eye – the NY Times article on escalating long-term care costs noted that the assisted living industry, according to its trade association, ALFA, now has a national resident population of 730,000, that the move-in age is now 87, and that the average time of residence is 2 years. As has been noted several times on this blog, if the move in age is rising, the industry must be continuously marketing its capacity. Tours with those not yet in need must be painful -- the assisted living resident increasingly resembles the nursing home resident of yore -- and at the same time dementia care costs have risen to their current daunting average level. Furthermore, dementia care is the most profitable service -- and fastest growing offering -- in today's assisted living industry.
May is Older American's Month -- service is local, but standards of care can be national. As the AoA puts it, unleash the power of age. And the federal government wants to help those who are aging. A few weeks ago after ASA ended, I posted about the inverted triangle of associations and federal websites all aiming one way or another at helping older adults. As you may know, there is a Senate Committee on Aging that includes long-term care on its issues list, and a Sub-Committee on Health and Aging that includes renewal of the Older Americans Act. There is a Center for Excellence in Assisted Living (CEAL) that promotes, understandably, improving quality in assisted living. In addition to those national entities, we have the various associations of lobbying, advocacy, and concern. These include senior housing and nursing home groups, LeadingAge, ALFA, and an association of state agencies, NASUAD (home and community services). Is there a navigator tool for consumers that helps decipher the web of entities that are trying to serve? And is there a common framework, a thread that even that connects all of these, other than the words senior, older, aging?
2.3 million elderly or disabled people living in nursing homes or assisted-living centers have an advocate in the ombudsmen, but the states are threatening their mission.
We don’t see ourselves as aging with dementia – and neither did senior housing providers. Chew on this thought from a senior housing strategist, who encourages providers to "look at entryways differently," Traci Bild says. "You often see a lot of furniture where people sleep in the lobby. Instead, make it a place where people can congregate to talk, rather than to sleep, by placing high top tables." Meanwhile, back at the reality ranch, where sitting at high-top tables, uh, may not work so well -- the average age of resident move-in to assisted living is now 87 -- says Allison Guthertz, Vice President, Quality Resident Services at Benchmark Senior Living: "These days when residents move in, they already need help with three to five activities of daily living (ADLs)."
