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.
This has been our battle cry for over twenty years. The benefits of keeping seniors at home with needed services has proven to be cost-effective, beneficial to the health of these clients and responsive to seniors’ desires. And yet, change has come slowly particularly in southern states. Under the pressure of skyrocketing Medicaid budgets fueled by the increasing numbers of low-income seniors our policymakers have had to shift toward funding more community instead of institutional care (nursing homes), what is called in the industry: “rebalancing long-term care.”
One state that has been successful in doing so is Oregon that rebalanced their budget back in the early 1980’s. Many other states have followed, including Washington and Colorado. The number of people receiving Medicaid-funded nursing facility care in these states grew at a much slower rate than in the rest of the nation from the inception of Medicaid home and community-based waiver programs in the early 19080s to 1994. The number of people in nursing homes as a proportion of the population age 75 and above in these states decreased faster than the average for the rest of the nation. Total annual Medicaid spending on nursing facilities also increased at a slower rate in the study states than nationally after controlling for growth of the age 75-and-older population.
Today only a handful of states remain committed to forcing seniors into nursing homes when no longer able to live independently – Kentucky, Virginia, Alabama and West Virginia do not pay for assisted living services. Although an increasing number of states have created Medicaid waivers to pay for assisted living services, the funding always falls short of the need which creates long waiting lists. clients in need of assisted living services cannot wait the two or three years it takes to receive an allocation. So seniors and disabled adults are still forced into nursing homes and we continue to pay for poor quality and undesirable care.
In 2003 our firm started the conversation with the Department of Housing and Urban Development urging them to join forces with the Department of Health and Human Services (federal Medicaid program) to properly fund community care at least for those living in public/subsidized housing. Seven years later, it happened and both departments partnered to create the Community Living Initiative that funds housing and services for low-income disabled adults. Seniors, however, have to wait longer and as of today no initiatives have been taken to address the issues of the seniors.
Apparently financial crisis alone will not prompt the federal government to act. I firmly believe the issue of low-income seniors ending up in nursing homes prematurely must arouse public opinion. Those most affected, the seniors, the families, the advocates, need to demand this change. Rather than being remembered as the “silent minority” we must be remembered as the generation that changed the way we care for seniors in this country.
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.