When the time comes to move to an assisted living facility there are some questions you must ask. It is a difficult, traumatic and long term decision. You have to make sure that the move is pleasant and right. Below are a set of guidelines/questions that can help in making your decision.
- Is the residence licensed? Is it a good location to family/doctors? Is the entire facility wheel chair accessible? Is the décor attractive and home-like? Is there good natural and artificial lighting?
- do the residents socialize with each other? Do they appear happy and comfortable? Is the facility clean and odor-free?
- does the facility assist with self-administration of medications? What is their policy on medication storage? Do physicians visit patients on the premises?
- Is there 24-hour help available? Is the staff friendly & properly dressed? Does the staff know the residents by name?
- Are units private or shared? What safety features do they have in each apartment? Can residents bring their own furnishings? Is there a kitchen area in the unit?
- Is there an activities program? Is there a wheelchair-accessible van for transportation? Do residents have access to computers and the internet?
- Do they provide three meals daily? Do they provide snacks too? Are there set meal times? Are there special diets available?
- Are the rates all-inclusive or do you have to pay more for higher levels of care? Do they accept the Medicaid Waiver/Diversion programs? If so, is the family/resident expected to contribute financially to help cover the cost of care?
Asking the right questions will help ensure that the decision made is the right one.
On November 12, 1995, an event occurred that completely changed the course of my life. While serving as Florida Secretary for Aging Services I was summoned to a public housing building in Fort Lauderdale, Florida where a fire had killed 12 of the residents. For the first time I came face to face with the squalid and precarious conditions in which low-income seniors in this country subsist. The image of that day never left me and I made a promise to myself that I was going to make it better. Charged with this moral obligation and strength I was able to secure a deteriorating public housing building in downtown Miami with the promise of turning it around and creating something new. With my political ties in Tallahassee still fresh I secured $1.2 million to retrofit and license that building. In six months it was full with a long waiting list, had become the model for the nation and had won four national awards. Some may say it was luck, I believe it was stubbornness and commitment that made it happen. I had fulfilled my promise. To the 104 seniors living at Helen Sawyer this was the beginning of the best time of their lives. End of story. I never had the intention of doing this over and over in twenty-three states. But it was no longer up to me; the notoriety that this little program gained made it impossible for me to turn the page. And so it began, my journey in replicating this common sense approach to providing 24 hour services to low-income seniors where they live so they will never be forced into a nursing home.
There is no doubt that good publicity helps in creating an innovation, but that alone is not enough. I knew that innovation is almost always built on rejection. There were so many obstacles that had to be overcome. The worst was the mind set of policymakers and public officials reluctant to change the way we care for the poor elderly. They seem to have a spiritual blindside that prevents them from seeing the human side of the dilemma. If I was going to replicate this program in other counties and states, government funding was critical. My experience in government was important in understanding government, what moves them; how to obtain their collaboration. We needed to gather some ammunition to win them over. How about doing more with less? With the funds they spent for each individual forced into a nursing home, I was going to care for four. How about if we could prove to them that our care involved changing lifestyles and improving health? We started gathering data that proved that we were avoiding hospitalizations, emergency admissions, reducing the number of prescription drugs and 911 calls. That certainly caught their attention and in 2010 our little company was able to change national policy. Funding this type of program instead of nursing home care became a priority. The Community First Option program was started in collaboration with two large federal agencies: Health and Human Services and the U.S. Department of Housing. The program was initially funded with $46 million. Until now, they did not talk with each other, and now they were cooperating in making it possible for low-income seniors to live with dignity in the comfort of their homes. What a novel idea!
Now, I said, we can concentrate in avoiding other obstacles in scaling our program. What would it take to convince private investors to provide the capital to purchase distressed properties and hire us to provide the services to this exponentially growing and long neglected population? A good return on their investment perhaps? Although corporate America needs to be seen as having a social impact, what they are truly interested in is good returns. Conquering corporate America became a major goal for us. We never forgot, however, that our social mission had to be safeguarded.
America is a relatively young country as far as the percentage of individuals 65 years and older in the U.S. today. About 12% of the population in the U.S. is 65 years and older. However, that percentage is projected to increase to 20% within the next decade. Compare those numbers with that of other countries like Japan with the highest percentage of seniors currently at 21.5% of the population. Global aging affects all aspects of our society: work, health care, retirement, services and housing, among others. One of the major challenges is what we call the dependency ratio which means that for every person age 65 years and older there will be fewer than two persons in the workforce and available to care for the older generation. Exceptions are those countries with high birth rates (Mexico, Iceland and Turkey) or in countries like Australia, Canada and New Zealand with high immigration. However, in most countries the dependency ratio will sharply increase from 2020 to 2050. It is becoming more important that we create new ways to care for this aging population that is cost effective and dignified. The U.S. has the highest per capita health care expenditure in the world with a per capita cost per individual of $6,714. Japan, on the other hand, has the lowest health expenditure with a per capita expenditure of $2,581, half of that of the U.S. Most of the expenditure in Japan is paid by the government.
During the Ashoka Summit held this month we were able to discuss with other Fellows challenges facing their countries. Masue Katayama, a Fellow from Japan, has worked for the past twenty years in providing services to the older population in Japan. She came to learn how our firm has been able to change how we care for this older population. We believe that the global financial crisis is pushing us to make due with less and to learn how to use government funding more efficiently. Our firm has a proven track record of being able to service three times as many seniors with the funding the government spends on one. Japan, along with many European countries, has older people and lower health care spending than the U.S. They do this by fixing prices and manipulating prices to keep costs down. Every two years the price of each treatment, test and medication is examined to see if excess profits are leading to overuse and if so the price is cut. This is not done in the U.S. because those who profit from high prices are so powerful. This rationing and price cutting impacts the ability to control chronic illnesses at an early stage. Instead of rationing, Japan should look at ways to improve people’s lives by systematically changing lifestyles through better diets, exercise, medication management and supervision. This is something that Japan and other European countries can learn from the U.S.
Masue and I sat down to establish a collaborative effort that will enable us to learn from each other. She visited one of our affordable assisted living facilities and was impressed with the home atmosphere and the improvement in the physical and cognitive health of our residents. We agreed to formalize this collaboration by her sending a group of her operators to the U.S. for a month to live and learn at one of our facilities. Mia will do the same as we know that there are lessons to be learned from Japan as they tackle the common challenges of global aging.
In June the U.S. Supreme Court will determine the fate of the healthcare reform and with it, the fate of many seniors in this country. There is consensus that healthcare reform cannot be viable if the public option is deemed unconstitutional. This comes at a time when the economic and health security of seniors is at its worst. Healthcare reform,although aimed at the 40 million uninsured individuals, provided great benefits to seniors who cannot afford long term care. Included in the healthcare reform were incentives to state to provide affordable long term care to seniors who want to remain in their communities and avoid costly nursing home care.
Lets take a look at what is at stake. Debt and deficit reduction proposals by policymakers include major changes to thre three major entitlement programs, Medicare, Medicaid and Social Security. Some proposals include raising the age of retirement to 67 years, asking higher income Medicare beneficiaries to contribute more to the cost of Medicare and federal block grants to states so they can pay the federal share of their Medicaid program expenses. One mistake made by policymakers is to look at each of these programs separately and failure to recognize how interrelated they are in their effect on the economic security and well being of seniors. For example, stopping annual increases in social security payments will result in less funds available to seniors to pay for healthcare.
Most seniors live on low or modest incomes, 1 in 10 have income below the poverty level ($10,458) and the number of seniors living in poverty increased when you take into account out-of-pocket expenses from 9 to 15%. Many seniors today do not have long term care insurance coverage which means that assisted living and community care services are unaffordable or that paying for them will require a larger outlay. It is predicted that low incme seniors will exhaust all their assets by the time they reach older age. It is estimated that 2/3 of those 65 years and older will need long term care services. Meaning that they will be solely reliant on Medicare and Medicaid to survive. And yet most states restrict long term care funding in community settings forcing these seniors to enter nursing home care prematurely at four times the cost. Dont they see the writing on the wall, or is it that they constantly engage in wishful thinking? Those who will fare the worst are minority groups. Poverty rates among black and hispanic seniors are more than twice as high as those among their white counterparts. To compound the problem they suffer from a multitude of healthcare problems, again higher than the white seniors. One wonders what information our policymakers rely on to make untimely and disastrous cut cutting decisions. Not our seniors.
We live in an aging world with countries like Japan and Italy with 21.6% of their population 65 years and older. Our nation is still relatively young with an elderly population of less than 13% but that is about to change. The baby boomers who started turning 65 last year will add 75 million more seniors and the percentage of seniors in this country will rise to 20% within the next ten years. This is good news if you are getting older while remaining healthy. Unfortunately for the large number of low and middle income seniors staying healthy and having access to services is not always an option. The growing number of Hispanic seniors continues to experience a litany of problems when accessing services, among them, language and cultural barriers, a fragmented service delivery system and lack of trained bilingual staff.
Take for example my own state of Florida where over one million individuals are 65 years and older and few have access to critical healthcare services. Luckly for our Hispanic community they are part of what is called the Hispanic paradox which means that despite their socioeconomic hurdles and lack of access they live longer than anyother ethinic or racial group by seven or more years. This is because Hispanic seniors are much healthier than expected and the reasons for this paradox are a matter of debate. Many suggest that factors such as diet, lifestyle choices and a strong social support network are key in understanding Hispanics’ better-than-expected health. Another favorable condition of Hispanics in Florida include declining disability rates, lower rates of Medicaid use and low utilization of nursing home care.