Timely articles featuring expert insights are intended to help senior living communities successfully navigate today’s challenges.
When comparing residents of nursing homes and assisted living, the similarities can be somewhat expected.
The average nursing home resident is around 85. The average assisted living resident is a bit older – 87. Both “typical” residents are afflicted with three or more chronic illnesses like diabetes and high blood pressure. Both may also have conditions like Alzheimer’s, heart disease, depression, arthritis, osteoporosis, COPD or cancer.
Residents of senior living communities outside the nursing home world have long enjoyed generally good health relative to their age. They have fewer chronic illnesses – and among those who do – access to fitness and wellness and effective medication therapy are usually successful in keeping it that way.
As an influx of seniors with rising acuities threatens to overwhelm senior living communities, clear communication about residents and medications is more crucial than ever. Where are the barriers coming from, and how can we overcome them?
Healthcare data and technology are the lynchpins of today’s advanced senior living industry. Working with our partner company Bright Spring Health Services, this article takes a deep dive into the vulnerabilities – and solutions – we face every day.
During 2018, more than 1,550 assisted living construction starts were logged. By the end of that year, the American Health Care Association/National Center for Assisted Living reported their assisted living members’ bed count grew by more than 20,400, to a total of 251,108. Slightly lower growth was reported the year before. Meanwhile, stable occupancy rates blessed the assisted living sector in 2018 – an average of 85.4%.
Thanks to technology and some very smart people across disciplines from medicine to engineering, there are a million ways to keep senior living residents safe today. Yet, old men still find ways to wander into the night. And infections still manage to evade even the most watchful eyes of competent nurses. When technology fails us all, there’s compliance. Compliance to treatment plans, to regulations, and, of course, medications.
During the early days of assisted living, seniors relished the luxuries and freedoms this novel concept brought to life’s closing chapters. But thanks to the unprecedented tsunami of 1950s babies who are aging in the 2010s, this sector is experiencing the most profound growing pains in its short history.
In today’s senior living communities, few issues are more pressing than building stronger workforces while wrestling with the myriad and mounting challenges of aging and long-term care. The issues are inextricable. Look no further than the rising acuity in assisted living residents and the medication dangers they face in communities beset by high turnover and over-worked nurses.
Health care issues in assisted living will undoubtedly gain greater traction than ever in 2019, reflecting the concerns of Americans in general based on national polling. As policymakers and pundits endlessly debate the mechanical issues, indisputable trends are beginning to emerge, and likely will begin to change the face of assisted living in the years to come.
In its late 2018 forecast white paper, Cantata Health notes how senior living communities must engage similarly-aged constituencies among both the workforce and loved ones of its customers. It addresses the pressures operators face in the coming year(s) this way: “Healthcare facilities will need to find new and innovative ways to engage families with the shifting of generations. Technology offers new ways for healthcare organizations to market to and engage families. Staying relevant with younger generations offers challenges, but will become imperative in 2019 as Millennials and Generation Zers begin making more decisions for aging family members.”
The assisted living sector will continue growing in 2019, according to several sources. The American Health Care Association/National Center for Assisted Living reports their assisted living members’ bed count grew by more than 20,400, to a total of 251,108 by the end of 2018. Slightly lower growth was reported the year before. Meanwhile, stable occupancy rates blessed the assisted living sector in 2018 – an average of 85.4%, but still slightly lower than that of independent living.
For the past few decades, investors and community executives have focused heavily on building upon assisted living’s allure as a hospitality haven where seniors with means could comfortably transition. But with rising acuity, more chronically ill residents moving in and a reformed healthcare system that has placed a premium on information to drive decisions, data has taken on an unprecedented importance in transitional care.
Under the larger umbrella of senior living, more chronically ill seniors may opt to stay in their assisted living apartment in lieu of a skilled nursing home. Under the fairly new federal Money Follows the Person (MFP) program, the government wants to give seniors more freedom to choose where they reside while accessing community-based health services. In early April, Congress approved The Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources and Care Act (EMPOWER), which reauthorized the MFP program.
Assisted living is booming. Along with this growth, there has been new challenges, one of which being staff attrition and turnover. Assisted living operators are now focusing on professional development as a key strategy for ensuring that their employees remain with the facility after investing time in finding, hiring and training them.
For long-term caregivers whose work focuses on physical therapy or speech pathology, the list of tools and resources is extensive. For those caregivers who work in assisted living memory care, however, every day poses new challenges as the mechanisms for diseases like Alzheimer’s are still not fully understood.
Since assisted living came into being in the 1950s, the industry has seen steady growth throughout the years. With the vast majority of residents being private-pay, assisted living has been spared of the challenges faced by many skilled nursing facilities: chiefly declining reimbursement and unpaid receivables, coupled with the increased scrutiny of government and quasi-government regulators.
With aspirin use in the elderly controversial because of their higher bleeding risk, the 2015 Beers Criteria by the American Geriatrics Society previously advised using caution in administering aspirin for primary prevention of cardiovascular disease for adults over the age of 80 and the 2002 ACC/AHA guidelines recommended that the decision to start low-dose aspirin in adults 60-69 with a 10 percent or greater 10-years cardiovascular disease risk should be an individual one.
A December 13, 2018 article in The New York Times explored some of the key challenges assisted living memory care providers are facing today. The article was an unflattering assessment of an industry that is growing so fast that assisted living providers and lawmakers alike are overwhelmed; asking very difficult questions about issues including inconsistent care and uneven regulations and citations, especially for incidents involving residents with dementia.
Seismic changes from demographic and market trends are increasing the demand for assisted living. The need is expected to continue to grow in the next decade, with the last of the baby boomers reaching age 65 in 2029. By 2030, potentially 74 million people will be seeking senior living communities, and assisted living is the fastest-growing segment of the market, multiplying at a rate of three to four percent a year.
Memory care residents is the fastest-growing population in the long-term care assisted living (AL) industry, with four in 10 AL residents suffering from dementia. Most are only one unmonitored exit or disorienting fall away from serious danger and irreversible harm. Thus, keeping this population safe, from both themselves and the world around them, is one of the greatest challenges for medical professionals who serve them.
The resident demographic in assisted living is undergoing significant changes. While it could have been easily and more narrowly defined as homogenous in the decades since its birth in the 1950s, that’s no longer the case.
Transitions of care from one senior living setting to another are fraught with risk. In spite of all the bells and whistles and policy manuals and webinars, health care staff are still human. That doesn’t change the critical need to get every detail right. One small mistake in communicating an in-hospital procedure or a new medication order can cascade into a series of problems that could land a resident back in the hospital, or worse.
The long-term care landscape was a very different place when the first assisted living community opened its doors in Portland, OR, back in 1981. Stellar Living, an independent living community in Utah, aptly describes the scene this way on its website. “Before the 1970’s there weren’t many options for aging seniors. You could have someone come to your home to provide in-home care, or go to a nursing home, which at that time were not very pleasant places to be. During this period, nursing homes were institutions where lower income seniors were sent to… die out of sight. These communities were cold and sterile, and the entire institution was known for neglecting and abusing elders.”
Seniors in the autumn years of their lives are as complex as any generation – whether it pertains to what they value or how they view the world, as well as their general health. And so it’s no surprise that growing complexity is increasingly being used to describe the myriad settings in which this demographic is spending their remaining years. The lines that once defined skilled nursing, independent living and aging in place are getting a little fuzzier every day.
Balancing equal parts of independence and care have always been a challenging exercise for assisted living communities. Seniors are attracted to such settings for the freedom they offer. Their families and loved ones, meanwhile, are looking more and more to caregivers to provide safe environments that include hyper vigilance of their changing healthcare needs. Nowhere is the more evident than medication management.
To the naysayers about the state of technological sophistication in senior living, consider these findings from a recent LeadingAge Ziegler 150 study, an annual joint project between the nation’s largest association of not-for-profit aging service providers and one of the nation’s leading underwriters of financing for not-for-profit senior living providers.
Employment in senior living today can best be described as one that is rich in demand and poor in supply. It’s simple supply side economics and no matter how one does the math, the answer is the same.
Few generations in history have been studied or viewed with a more critical eye than Millennials – the group of people born between 1980 and 2000.