senior living

Dementia care – it’s 4:00 and what’s happening?  In a nearby memory care unit in an Assisted Living community, the movie has ended, the credits rolled. Next up – visitors hear loud yelling and observe a staff member separating and redirecting an able-bodied resident. Count the number of residents in wheelchairs -- nearly half of the unit -- awaiting some physical care before dinner. These residents seem ever-more frail -- likely because they are delaying move-in until the need is urgent. Often it appears that staff is supplemented with home health or companion services -- note that these providers are assigned to individual residents, not the group -- just like the resident-specific role played by visiting hospice workers. It may appear that there are many staffers around, but minus the one-on-one folks, there aren't enough staffers to keep everyone else occupied. Now consider the dependency on staff to engage these otherwise-bored and idle residents. Soon it will be dinner time and the activities person will have left for the day. Staff members (who earn a national average of $11.10/hour) get busy with ADL-related chores before/after meals and before bed.

Reinventing the aging experience – who will transform this market? Over the weekend I saw a Woody Allen movie (he is now 77 and in trouble in Mumbai), read an article about Robert Redford (he is also 77), noted that Bill Cunningham -- the NY Times bicyclist-about-town -- is now 85, Betty White (accused of ageism this week) is now 91.  These are well-to-do and well-noticed folk – likely they feel secure in their limos, the NY streets or wherever. You wanna bet that none is considering or would ever consider moving into a CCRC or an Assisted Living, or wearing a PERS device around their neck, mobile or otherwise?  

Incubators and contests -- do they enable innovation?  Paul Krugman's interesting article about GE’s competition to find a new design raises a question about how to boost innovation and lower its cost. If you read the article, entitled 'Complexity is Free' – you will discover how a simple contest, fielded internationally, generated a design improvement at almost no cost for GE: "The winning prize pool [was] $20,000, spread out across 8 finalists, with awards ranging from $1,000 to $7,000 each." So for $20K, GE got something it wanted, layered that something into a design process that enables continuous revision to designs without new infrastructure investment (the 'free' in the title.) Does anyone else find it interesting that there was no internal engineer who could figure out how to design a lighter-weight bracket component -- and that a contest was required? Or was this a publicity stunt to generate good will for GE? 

Consider the data, check elsewhere, and discard this report. This kind of thing catches my eye. You know by now which single age demographic income group saw a statistically significant increase in median income since the recession (supposedly) ended in 2007. The New York Times helpfully tells us – it was those 65-74 folk. Says the Times insightfully: “helped perhaps by the decision of some older workers to remain in the work force or re-enter it.”  A long way down in the article, we learn that the 5.1 percent increase for those 65-74 put them at a median income of $43,000 -- the national median rose to $52,100 in June -- even though in many cases the head of the household was retired. Guess those 65+ must be doing okay.

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.