senior living

Why wait for a crisis to decide to deploy web cameras in senior care?  Did you know that, according to the Administration on Aging, this  is the year of elder abuse prevention? Perhaps it should be the year for webcam deployment in all senior care settings, especially now that that the Frontline story aimed an investigative spotlight at assisted living. So I heard a story this week about an elderly person abused by a home care worker – not surprising, really, when a care recipient is frail and no one is around except the care provider.  The family subsequently placed a web camera in the home.  According to a family member, it was quite a deterrent for the subsequent hires, made aware from the start about its presence. Plus, it was as an enabler for day-time check-ins while an adult daughter was at work.  So why aren’t web cameras ubiquitous in senior care settings – especially to observe care activities like entrances and exits of workers when residents are less mobile, in bed or stranded in wheelchairs? Your opinions are welcome:

When the lights go on – much becomes visible. Warning – rant on. I have to ask, what do you think is the biggest fear of the Assisted Living industry? Is it PBS and documentaries about their industry?  No, many have rationalized their own organizations or will be contemplating new ways to manage bad publicity and thus prepared, they moved on. Lawsuits? They are certainly an issue – and cost time and potentially substantial amount of money. But risk managers and lawyers are around to help avert through policy and procedures, training, etc.  No – the real and pervasive fear of the industry is federal regulation. And how hard they work to avoid it at all and enormous cost – lobbying is vigilant and continuous to ensure that the industry remains within the regulatory (and wildly varying) domains of the states.

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?