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Tag: Assisted living facility

  • Why doesn’t the federal government regulate assisted living facilities?

    Why doesn’t the federal government regulate assisted living facilities?

    The Senate Special Committee on Aging is looking into quality and cost issues in Assisted Living Facilities, reports Jordan Rau for KFF Health News. But, the federal government does not regulate these facilities, even though it pays for them in some cases for people with Medicaid. It’s not likely that Congress will enact legislation to regulate them.

    More than 800,000 Americans live in an Assisted Living Facility (ALF) today. ALF residents include people who can’t bathe themselves or feed themselves. People with dementia. People unable to walk unassisted.

    The cost of living in an ALF is prohibitive for most Americans, typically around $4,500 a month, way more than the typical Social Security check. In cases where residents need substantial amounts of care, the cost can be $10,000 a month. Some facilities impose additional charges for basic services. One ALF charges $93 a month simply to order medications for its residents.

    Medicare does not cover ALFs.  And, only 20 percent of ALFs accept Medicaid patients. But, one argument for federal oversight of ALFs is that the federal government spends more than $10 billion dollars on these ALF residents.

    What services do people get for their money in an ALF? They should get assistance with activities of daily living. However, staffing levels in ALFs are too often low and workers can be poorly trained.

    Today, it’s up to each state to regulate ALFs. Given that few states have the will, the skill, the power and the resources to oversee these facilities, many patients in these facilities are not getting quality care.

    Monitoring of ALFs is inconsistent across states. And, data is hard to secure if you want to understand how different ALFs operate. Federal oversight is needed to protect ALF residents across the US.

    Richard Molloy, who runs the Long Term Care Community Coalition, explains that “too many [long term care facilities] take in or retain residents for whom they are unable to provide safe care and dignified living conditions. Too many residents and families are at risk for financial exploitation and even fraud.”

    Here’s more from Just Care:

  • If you need long-term care services, how will you get them?

    If you need long-term care services, how will you get them?

    The majority of older adults will need long-term care services at some point. But, caregiving costs for older adults are super high, stemming from significant labor and facility costs, along with high demand. If you need long-term care services, how will you get them?

    More and more people are looking for adult day care, assisted living facility care and nursing home care. For many of them, relying on volunteer caregivers, such as friends and family, is not possible. But, the cost of paid care is prohibitive, swallowing up years of savings quicly. Caregiving costs increased more than 20 percent between 2012 and 2019 and continue to rise.

    Medicare does not pay for long-term care services. At best, Medicare will cover 100 days in a rehab facility or nursing home for people who need daily skilled nursing or therapy services. And, most Medicare Advantage plans inappropriately deny coverage for rehab and nursing care beyond a few days.

    But, a stay in a rehab or nursing facility can cost thousands of dollars if you have to pay out-of-pocket. The average cost of a nursing home stay is now more than $9,000 a month. The average cost of a stay in an assisted living facility is more than $4,500 a month.

    Caregiving costs are a lot higher in some states than others. In Massachusetts, average costs for a nursing home stay can be more than $15,000 a month. An assisted living facility stay can cost well over $8,000 a month.

    More than four in five households with someone over 65 need some type of care. Almost a quarter of them have significant care needs, including round the clock care. Almost two in five need help, though not round the clock. Only about one in five of them need minimal care, such as help getting groceries and cooking.

    Here’s more from Just Care:

  • Assisted living facilities should do more for residents

    Assisted living facilities should do more for residents

    Assisted living facilities should address people’s medical and mental health needs. Older and frailer people are now living in these facilities. Judith Graham writes for Kaiser Health News on a report earlier this fall in JAMA Network that assisted living facilities are not meeting their residents’ needs.

    Today, more than half of assisted living facility residents are over 85. And, more than three in four need help with activities of daily living, particularly bathing. Half need help with toileting.

    Most assisted living facility residents have high blood pressure. About one in three have heart disease, arthritis or depression. More than four in ten have dementia or a cognitive impairment. And, more than one in ten suffer from a serious mental illness.

    Experts on a panel addressing resident needs in assisted living facilities recommend “a new standard of care,” including a requisite number of health aides and an on-site registered nurse. Staff need to be available to provide assistance in a timely manner when people fall or otherwise need help. At some facilities, there’s just one staffperson for 40 residents.

    Moreover, many assisted living facilities do not have adequately trained staff. It is not unusual for staff to lack training in caring for residents with dementia or other cognitive impairments as well as for patients taking multiple medications and controlling infections. During Covid, one in six more residents died than prior to Covid. Of course, all of these recommendations cost money, which each state will need to factor into any regulatory reforms it adopts.

    If you’re shopping for an assisted living facility, be sure to check the ratio of staff to residents as well as the training of staff. Well-trained staff are far more likely to provide good quality care. Also, inquire as to whether the facility does formal assessments for dementia, as it is so common among residents and should be properly treated.

    In fact, a good assisted living facility should formally assess all patients and develop an individualized plan of care for each resident. Patients’ care goals should be understood and attended to.

    If a loved one needs memory care at an assisted living facility, look for a facility with well-trained staff. You will pay a lot for a stay in the memory care unit. And, well-trained staff should be part of the package.

    Today, there are nearly 29,000 assisted living facilities serving more than 900,000 residents. Each state has its own set of regulations governing how they operate. They are intended to meet both social and medical needs of residents, but they are all different when it comes to what they offer residents. There are no federal regulations.

    Here’s more from Just Care:

  • Caregiving: A mediator could help minimize stress among siblings caring for an aging parent

    Caregiving: A mediator could help minimize stress among siblings caring for an aging parent

    Growing old can be difficult, not only for yourself but for your loved ones. It is not uncommon for siblings to drift apart or, worse still, do battle, around how best to care for an aging parent. Next Avenue reports on an interesting strategy for reducing caregiving tension and worry: Hire a mediator.

    A mediator helped one family reach consensus around whether their mom should move into an assisted living facility. The mediator helped them to each share their views, without a lot of emotions at play. The mediator helped them select the assisted living facility and to assume different responsibilities for the move.

    There are always myriad considerations and many items to nail down. One sibling took responsibility for talking to their mom about stopping driving. Another agreed to help their mom with finances. One took responsibility for medical issues.

    Mediators can be a help with a range of elder care issues. There need not be any legal disputes. The goal is for the family to reach agreement as peacefully as possible.

    Mediators will usually speak with each family member individually, including the older adult if possible, to give everyone a voice, get a sense of where people stand on key issues and each person’s ability to be helpful. After that, the mediator can lead a zoom or in-person meeting of the family.

    At the end of the day, every family member will understand all that needs to happen and each person’s role in making those things happen.

    Does your family need a mediator? It depends on how much you are getting done without one and how much stress it entails. Try not to wait for a medical emergency.

    Caregiving is filled with important responsibilities: medical, financial, legal, domestic, you name it. Here’s a link to a range of things you might want to think about if you’re caring for a loved one. Getting the job done is time-consuming and often terribly painful even without the added stress of reaching consensus with others. The goal is to make it as joyful and stress-free as possible.

    Here’s more from Just Care:

  • New lower-cost housing option for older adults

    New lower-cost housing option for older adults

    At some point as they age, the majority of older adults will need assistance with daily activities as a result of a disability. Sally Abrahms reports for Next Avenue on a new housing option that offers long-term supports and services. Opus Newton, a non-profit facility, is a lower cost alternative to luxury assisted living facilities.  To keep costs down, it requires its residents to volunteer some of their time.

    Right now, older adults who live in an assisted living facility can easily spend $4,000 a month or more.  The founders of Opus Newton, a new housing option, intends to keep costs below that level right in the Boston area. How?

    A three-pronged strategy:

    1. Requiring residents to volunteer at the living facility for at least 10 hours a week, reducing staffing costs.
    2. Locating the facility by a park, reducing their costs for outdoor activities.
    3. Collaborating with service providers to offer a range of additional services at lower cost.

    Someone on staff will help residents identify health care providers to meet their daily needs. And, residents will have help navigating the insurance maze and their medical bills. Home care agencies will come to the facility to see residents on an as-needed basis rather than in four-hour periods, reducing costs to people who have minimal needs.

    The Opus Newton facility will have 174 units when it is completed in 2025. Residents will pay an upfront fee of between $302,000 and $732,000 that is 80 percent reimbursable when the resident dies or leaves the unit. Of course, that is still a huge price tag for many.

    However, residents save on monthly fees relative to most assisted living facilities. Instead of a fee of $4,000 or more a month, the fee is likely to be $2,500 or less a month. The fee will cover food, electric, maintenance, activities and help with medical issues, but not parking or housekeeping or any types of physical care.

    The facility will abut a community center. So, residents who join that center will have the benefit of its gym, classes, services, and events. They will also be part of a multigenerational community.

    What types of volunteering? Gardening, organizing activities, sitting at the welcome desk.

    Next door to Opus Newton are 146 subsidized apartments for older adults. And, Opus Newton will share some services and programming with that facility.

    Here’s more from Just Care:

  • Coronavirus: Where to live as you age?

    Coronavirus: Where to live as you age?

    The novel coronavirus has in no small way taken over all of our lives. It is also leading us to reconsider where to live as we age. Judith Graham reports for Kaiser Health News on new thinking among older adults about housing.

    Given the inability of so many nursing homes to contain the virus, many more people now recognize the dangers of ending up in a nursing home. As of now, the latest data show that 70,000 nursing home and assisted living residents and staff have died of COVID-19. Indeed, all group housing options need a rethink. Independent living is seeming far more attractive than ever before.

    At least in the confines of your home, you can control your environment. Other people are not in charge of your day-to-day activities, who you see and who can visit. You can protect yourself.

    Graham reports that some older adults are thinking ahead about a living environment where they can get assistance when they need it. Others are thinking about how best to age in a way that minimizes social isolation. In both cases that could mean owning or renting a bigger home, where there is adequate space for multiple people.

    Some older adults are waiting the pandemic out before they make a decision. At this point, no one has a good sense how long the pandemic will last or whether it will ever fully go away. But, they think they are more likely to avoid exposure to COVID-19 if they are in their own homes.

    Of course, getting care if needed is the challenge for anyone choosing to remain in their homes as they age. It can be expensive. And, good care can be difficult to find.

    Living on your own presents other challenges. Being able to engage with others might not be easy. In a group environment, it’s far easier to be around other people. And, then there’s the question of getting supplies, including masks and other protective equipment.

    All of these decisions turn in part on what’s affordable. For a growing number of older adults, eight million, living in a group facility, be it independently or with assistance, is not affordable. That’s in addition to the more than seven million older adults who live in poverty, with annual incomes under $12,000.

    If you or some you love is considering moving, here are some questions to consider:

    • What is the facility saying to its residents and their families about COVID-19?
    • Has there been a COVID-19 outbreak at the facility and, if so, is it letting people know about infections and death rates
    • How is the facility keeping its residents safe?
    • What is the facility’s plan and supplies in the case of a hurricane or other natural disaster?
    • How does the facility provide social engagement for its residents?
    • What is the financial situation of the facility? Can it withstand a drop in occupancy?

    Here’s more from Just Care:

  • Coronavirus: Strike teams step in to help nursing home residents and staff

    Coronavirus: Strike teams step in to help nursing home residents and staff

    Nursing homes and other residential facilities have been hard hit by the novel coronavirus, with residents and staff easily representing 40 percent of lives lost in the US. What do you do when there’s a natural disaster of this sort? The New York Times reports that  some counties are sending in strike teams–medical workers and other emergency responders–to  help nursing homes and other residential care centers and provide aid to residents.

    Strike teams are usually made up of eight to 10 people from local health departments, private businesses, nonprofits and emergency response agencies. They bring their expertise and assistance to the nursing home disaster at the request of a facility. For example, county nurses and doctors may be called upon to step in for nursing home staff who become sick. They might test staff and residents for COVID-19 and provide care to residents. By so doing, they can help keep these residents from needing to be hospitalized.

    In Henderson County, NC, a rescue squad of volunteer paramedics set up tents where staff could take off their personal protective equipment. They taught staff important safety protocols. Residents’ families and staff received emotional support from chaplains and mental health therapists. And, someone with PR expertise was charged with helping family members understand the plight of residents in the facility.

    The goal is to slow the spread of the virus through better coordination of care. A strike team response is often used when there is a hurricane or other natural disaster. The inability of many nursing homes to contain the spread of the novel coronavirus within their facilities is just that, a natural disaster. It’s far simpler to help people on site with a team that knows how to manage the emergency than to remove people from the site.

    States, including Texas, Massachusetts and New Jersey, have taken on some emergency response work at nursing homes and other long-term care facilities. A bi-partisan bill in Congress would appropriate money for these states to continue this work. Though, it’s not clear whether it will be enacted into law.

    Now, more local agencies are taking emergency response measures to help the thousands of understaffed and under-resourced nursing homes and assisted living facilities in small communities across the country.

    While there is no data yet available on the benefits of the strike team approach, experts say it makes sense and, anecdotally, people say it is working.

    Here’s more from Just Care:

  • Will nursing homes and assisted living facilities be able to keep the coronavirus from spreading to their residents?

    Will nursing homes and assisted living facilities be able to keep the coronavirus from spreading to their residents?

    Jordan Rau reports for Kaiser Health News that for quite some time nursing homes have not been following basic protocols to contain the spread of viruses and bacteria. The situation has only gotten worse since 2017. And, because assisted living facilities are not subject to government health inspection, we have no clue how well they do in containing the spread of viruses and bacteria.

    Kaiser Health News found that more than six in ten nursing homes–9,372 nursing homes–have received citations from government inspectors for deficiencies in controlling infections. Those nursing homes with fewer staff had a greater likelihood of receiving a citation. It’s another reason to avoid chain nursing homes, which tend to have fewer staff.

    When choosing a nursing home, bear in mind that the government’s star-rating system tells you very little about the quality of a nursing home. Forty percent of five-star nursing homes have been cited for infection-control deficiencies. Five people at Life Care Center of Kirkland, Washington, which has a five-star rating, have died of the coronavirus.

    Facilities that have been cited for deficiencies often have workers who do not wash their hands each time they see a patient or do not wear masks or gloves when they are with contagious patients. These deficiencies can cause infections  to spread.

    Health inspectors treat these deficiencies as minor in almost all instances, so nursing-facilities have no incentive to change their practices. Only in 109 out of 13,000 citations were these deficiencies treated as serious threats to patients. Nursing homes with these deficiencies are generally not fined or penalized in terms of their star ratings. But, between the flu and MRSA or other antibiotic resistant bacteria, each year nursing homes have as many as 3.8 million infections which kill about 388,000 residents.

    In some instances, staff who are sick do not stay home and infect other staff and nursing home residents. And, when staff stay home, it can sometimes be difficult for nursing homes to find replacement staff. There is a shortage of health care workers across the US.

    As of 2016, the Centers for Medicare and Medicaid Services requires an infection preventionist–an employee in charge of infection control–to undertake training and work part-time or full-time in every nursing home. But, the Trump administration has proposed to do away with this on-site staff person. It wants the preventionist simply to spend “sufficient time” at a nursing home to oversee infection-control initiatives, whatever that means.

    Here’s more from Just Care:

  • Roundup: Housing options for older adults

    Roundup: Housing options for older adults

    Where you live can play a large role in your mental and physical health. There are a range of housing options for older adults to consider, meeting a variety of needs. Here’s a round-up of some of the most notable options.

    • Aging in place—Of all the options, remaining in your home and community as you age or “aging in place” feels best to most people. There is already familiarity with the home, neighborhood and community resources. Medical and social networks are generally in place. But, can it meet your long-term care needs?
    • Cohousing—This may be the newest type of housing springing up for older adults. These housing complexes are designed for a group of people who want to create their own community, retaining their own housing unit while sharing common spaces and other facilities. With cohousing, the group might agree to share paid caregivers as well.
    • Tiny houses—These small homes, generally no more than 400 square feet, offer people who are ready to downsize significantly a way to simplify their lives and save money on maintenance. And, you can continue to live independently in the privacy of your own home. The question is what happens when you need long term services and supports.
    • Green homes—Launched in 2003, they are small intimate nursing homes, where aides have more time to spend with residents and work to accommodate their needs, be it a late breakfast or a trip to the doctor’s office. There are now 242 licensed homes in 32 states and 150 more being developed.
    • Continuing care retirement communities—CCRCs offer housing, along with a range of social services and health care services, so you can live independently and, if the need arises, with less or more assistance.
    • Assisted living facilities–Assisted living facilities offer housing and meals as well as some social, personal care and housekeeping services. Some assisted living facilities offer small homes and others offer apartments. Most offer a common dining room.

    If you decide that you want to live entirely independently, in your home or a smaller home without long-term services and supports, plan ahead for when you may need those supports. Modifying your home sooner rather than later could prevent an unneeded fall. It could also allow you to manage in your home if you have a disability. Think through what you would want to do if you cannot remain safely in your home.

    Depending upon your situation and where you live, you may be eligible for PACE, a Program of All-Inclusive Care for the Elderly in your community. PACE provides you with the long-term services and supports they may need so that you can live safely in your home.

    If you choose to move, be sure to consider the location carefully. If you will no longer be able to see your doctors, identify new doctors and schedule appointments with them before moving. Think about whether the new location is convenient for family and friends to visit. If you like walking, make sure it is a walkable community. And, contact the local area aging on aging to learn about community resources and other benefits for older adults.

    Here’s more from Just Care:

  • Assisted living facilities present serious risks for some people

    Assisted living facilities present serious risks for some people

    In a New York Times op-ed, Geeta Ananad warns against expecting assisted living facilities to meet the needs of aging parents once they lose their independence. Rather, she explains that assisted living facilities can present serious risks to older adults who are not able to function independently.

    To be sure, most people have no desire to end up in a nursing home, even if they offer 24-hour care. Ananad argues that an assisted living facility is not a substitute. Most of us will not be self-reliant until the day we die. And, if we cannot care for ourselves, we likely should not be in an assisted living facility.

    Don’t believe the marketing hype about assisted living facilities. They appear to be a good financial investment–with close to 15 percent annual returns, of late. But, assisted living facilities likely are not where you want your parents, or for that matter yourself and the people you love, to live out their lives.

    Assisted living facilities have the advantage of offering older adults companionship, activities and social interactions that they often cannot get at home. As you need more care, however, it becomes harder to rely on an assisted living facility, as much as you might like to. Once you need help walking or toiletting, or become mentally impaired, assisted living facilities are generally ill-equipped to meet your individual needs.

    Half of assisted living facility residents are over 85 and more than four in ten have dementia; they need fulltime attention, which is generally not available to them. For most people who are not independent, the “24-hour” monitoring an assisted living facility offers is not enough to provide needed assistance and to ensure people are safe. According to Eric Carlson, the directing attorney for Justice in Aging, the assisted living facility system is broken.

    Unlike with nursing homes, the federal government neither licenses nor oversees assisted living facilities. And, states do a poor job of regulating them. Assisted living facilities often do not have adequate staffing or properly trained staff and generally are not even required to have medical directors to review care for patients. (NB: Nursing homes must be licensed and meet strict regulatory standards and still they too often do not deliver the care people need.)

    The average cost of staying in an assisted living facility is nearly $6,000 a month. The cost will only increase if regulations require more staffing and more trained staff.

    Ananad proposes a Japanese model for paying for long-term care–a mandatory national long-term care insurance system, which the government helps pay for and is also supported by payroll taxes and premiums. Better still, Medicare for All, a single-payer cost-effective universal health care system, would spread the cost of long-term care across the entire population.

    Here’s more from Just Care: