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.
As states begin to provide more home and assisted living services to seniors the number of nursing home beds begins to decline. A study done by Harvard Medical School found that a 10% increase in assisted living capacity led to a 1.4% decline in private pay nursing home occupancy. Most nursing home residents pay privately for nursing home care thus don’t affect the occupancy in Medicaid beds. In order to decrease the number of nursing home Medicaid beds, states must make an effort to increase funding for Medicaid clients living in nursing homes that want to receive services at home or in a Medicaid funded community care (assisted living) facility. To this day, the private assisted living industry takes Medicaid eligible residents only if they have an occupancy problem. They prefer not to deal with the complexities of billing the government and the excess of monitoring and reporting that goes with having a Medicaid resident. However, state Medicaid agencies are hard pressed to reduce the number of individuals in nursing homes paid by Medicaid if they are going to see reductions in their Medicaid long-term care budgets.
Although this move benefits clients who wish to remain at home, it drastically impacts the financial viability of nursing homes across the U.S. With less private paying clients nursing homes will start cutting back essential services to an ever growing number of very frail clients. What is more, some states like Pennsylvania are billing family members for the cost of nursing homes. The Pennsylvania law stipulates that family members of nursing home clients are ultimately responsible for the cost. Some families have been billed some $96,000 for the care provided to a family member residing in a nursing home.
At the end someone has to pay, either a family member or us, the taxpayers. What the story tells us is that long-term care in the U.S. is broken and needs to be reformed soon. One answer will be for states to continue to rebalance their long-term care program, provide more community care and make it easier for providers to want to work with the government.
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.
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.