Here is the text of the email I sent to NAPA@hhs.gov

Last year I wrote a blog on this subject (see http://www.evergreenchalet.com/2011/04/choose-assisted-living-facility/). The content is still very much current and worth reading. However, at this time I would like to look at the topic from a different angle.

When prospective residents and/or family members come to Evergreen Chalet to check us out, quite often comments and comparisons are made about the size of the rooms, the furniture and the overall “look” of the place. Sometimes we hear about how much larger the rooms are at some of the facilities ran by big corporations, their new furniture, dining room accommodations, etc., places that of course charge almost twice as much as we are charging.  It seems to me that, unfortunately, some people associate the amount of money they have to pay with the quality of care they would receive, i.e. the more money it costs, the better the care. This, of course, is almost never the case.

Clearly, these big facilities have to charge more money because it costs them a lot more to pay for these new buildings, fancy furniture, top heavy corporate administrators and many other niceties that make the place look like a very expensive hotel or resort. But none of the above translates into better care. Care is provided by caregivers. The better the ratio of caregivers to residents, the longer the caregivers stay with the company, the better the training the caregivers receive – the more likely it is that the residents will receive great care. So if you or your loved one require minimal care, are in fairly good shape, fairly independent, then you could concentrate more on the general looks and atmosphere of the place. However, if you need help with some of the activities of daily living such as bathing, toileting, transferring, etc. or perhaps a touch of Alzheimer’s, then you should concentrate more on the quality of care the community can offer and less on the size of the room and the quality of the furniture.

The decision to move into an assisted living community is a difficult one and the move itself very traumatic for the resident. So it is of utmost importance to make sure that there is a good match between the needs of the resident and what the community can offer in order to avoid repeated moves. Luckily, there are a number of good resources that can help one to evaluate assisted living communities and make the right choice.

1. Choosing a Non-Medical Out-Of-Home Care for Seniors in California

www.ccld.ca.gov/res/pdf/NMOHC.pdf (from Community Care Licensing Division)

2. Residential Care / Assisted Living: How to Find and Evaluate RCFEs

www.canhrorg/RCFE/rcfe_find.htm (from California Advocates for Nursing Home Reform)

3. Guide to Choosing an Assisted Living Residence

www.alfa.org/images/alfa/PDFs/getfile.cfm_product_id=94&file=ALFAchecklist.pdf (from Assisted Living Federation of America)

4. CARR’s Guide for Evaluating Assisted Living Facilities

www.rcfereform.org/news/CARRs_Guide_for_Evaluating_Assisted_Living_Facilities (from Consumer Advocates for RCFE Reform)

It seems to me that more and more prospective residents and their families are using the Internet to search for an assisted living community. Perhaps the word is out that referral agencies are not very helpful in narrowing down the best communities that would fit the needs and wants of the consumers. (for more info on this subject please see my blog: http://www.evergreenchalet.com/2011/04/choose-placement-referral-agency/ ).

Searching the Internet is a very powerful tool if one learns how to use it properly. There are thousands of good sources that cover the mechanics of searching. Reading just a handful of these articles and following their recommendations will certainly improve the results of your search.

I am going to concentrate only on one element of the search: the key word. This is the word or words or phrases you use to describe what you are looking for. It is very important to use them properly, otherwise you end up with too much information, too little information or useless information. A rule of thumb is that we should use 3-5 words or phrases (a phrase is a combination of two or more words, ex. “assisted living facility”).

A recent article in the Senior Living Executive, a journal published by the Assisted Living Federation of America(ALFA), entitled Keyword Search Phrase Volume and What It Means for Your Website, quotes some interesting data from Google. The figures show (in thousands) the number of U.S. monthly searches for the top keywords. Here they are as ranked by Google:

#1. nursing home(s)  3,330;  #2. retirement home(s)  1,496;   #3. assisted living  823;   #4. retirement community(ies)  669;   #5. senior housing  450;   #6. senior living  450;   #7. long term care  368.

For specific levels of care, the ranks are:  #1. (in/at) home care  1,830;   #2. hospice  1,000;   #3. home health care  450;   #4. independent living  135;  5. hospice care  135;  6. skilled nursing  110;   #7. respite care  41;   #8. Alzheimer’s care  27;   #9. dementia care  22;   #10. memory care  22.

These numbers show that many prospective residents still search using older terms: “nursing home(s)” and “retirement home(s).”  This means that unless assisted living facilities (ALF) have used these keywords (tags) on their websites, which they usually do not, the prospective resident will not be able to retrieve a great list of ALFs.  So it makes good sense for prospective residents and their families to become familiar with the newer terminology used by assisted living professionals in order to increase the effectiveness of their searches. Some of these new words and phrases are:  “assisted living community” (“instead of assisted living facility”); “resident” (instead of “client” or “ patient” or “consumer”);  etc.  Most importantly, the searcher should understand the difference between a nursing home and an assisted living community. Simply put, if you or your loved one needs assistance with any of the activities of daily living (ADLs): bathing, transferring, toileting, dressing, grooming, feeding or help because of affliction with Alzheimer’s or dementia, then you need an assisted living community, not a nursing home and not a retirement community.

Here is what Andy Cohen, co-founder and CEO of Caring.com had to say in his congratulatory letter: “Our research shows that word-of mouth recommendations from others outweigh all other factors for caregivers choosing an assisted living community for a loved one. These first-hand testimonials are consistently cited as more important than anything else, including price and location, which are second and third in impact respectively.” In its press release, Caring.com also notes that “Characteristics consumers often discuss in a five-star rating for an assisted living community include care that is personalized and provided with a genuine concern, homelike amenities and décor, a wide variety of activities, and high level of cleanliness.”

Personally, I would add one more characteristic that in my opinion is just as important, if not even more important: a genuine love and respect for our residents; the conviction that they should be treated like they would be our parents. At Evergreen Chalet this characteristic is inculcated in all of our caregivers and it is the foundation of our organizational culture. I am convinced that, in our case, it was this characteristic, above all others, that earned us the high praises from families and residents.

I read Jaclyn Allmon’s posting on ALFA’s discussion group http://www.linkedin.com/groups/Will-Village-Movement-Gain-Momentum-1737157.S.80516243?view=&srchtype=discussedNews&gid=1737157&item=80516243&type=member&trk=eml-anet_dig-b_pd-ttl-cn&ut=1lh4B_NnNY5B01 commenting on an article published by Associated Press on November 12, entitled “Aging Americans Can Stay at Home With Aid of Villages” and featured on the Linkedin website: http://www.linkedin.com/news?viewArticle=&articleID=908363755&gid=1737157&type=member&item=80516243&articleURL=http%3A%2F%2Fwww%2Efoxnews%2Ecom%2Fus%2F2011%2F11%2F12%2Faging-americans-can-stay-home-with-aid-villages%2F&urlhash=zcn8&goback=%2Egde_1737157_member_80516243

The Village is, from lack of a better term, a kind of cooperative formed by individuals or couples (from 35 to a few hundreds) funded by membership fees (averaging between $500.00 and $700.00) and run by a board of directors. Research shows that those who rely on the Village love the system. However, the village model has many limitations.  One major problem is sustainability. Most villages cannot survive without donations, grants and volunteer workers.

I would like to learn more about the village model; the article is not very clear on what exactly is the Village offering to its members. So if anyone knows about some good sources of information, please direct me to them. As to Jaclyn’s posting and the comments made to it, I tend to agree with Jaclyn. The health and well-being of our seniors is too important to leave it in the hands of amateurs or volunteers, no matter how well intended they might be. Yes, we need to search for alternatives to assisted living facilities and make access to long-term care for our seniors more affordable, but not on the expense of the quality of care we provide.

In the last few days there were a number of articles and blogs about The Green House Project.

The Huffington Post quotes Dr. Bill Thomas, Green House Project Founder and Director of Innovation  as follows: “Conventional long term care makes the doctors and nurses the stars of show, in the spotlight all the time. The Green House makes the elders the stars of the show…the doctors and nurses are still there, but they’re backstage, where they’re supposed to be.”

http://www.huffingtonpost.com/2011/11/02/green-house-project-longterm-eldercare_n_1070458.html

The article also quotes Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation which partners with the project saying that  ”By altering the facility size, interior design, staffing patterns and service-delivery method, the Green House model provides residents better, safer and more personalized care. As a result, elders are happier and healthier. They have more enjoyment in life, remain independent longer and receive more individual attention from a caregiver each day.”

Laury Tarkan writes in the The New York Times in an article entitled A Nursing Home Shrinks Until it Feels Like Home( November 1, 2011 page D5) that “The notion that elder care should be de-institutionalized is a popular one. According to a poll released in September by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health, 82 percent of pre-retirees (adults over age 50 who have not retired but plan to) and 78 percent of retirees are somewhat or very concerned about being in an institutional environment that is not as comfortable as a home.”  The author mentions that “There are 117 Green Houses across the United States now, part of a quiet but intriguing effort to de-institutionalize elder care.” Some of the Green Houses have only 10 residents with a staff of two CNAs who perform all the jobs and a certified nurse who support two or three houses.

“If you have one person doing everything, they can spend more time with the residents and get to know somebody as a real person,” said Robert Jenkens, a director at NCB Capital Impact, a nonprofit community development finance institution that has partnered with the Robert Wood Johnson Foundation to provide consulting and loans for organizations developing many Green Houses.

The Green Houses look very different from a traditional nursing home. They have large living and dining areas with communal tables, private bathrooms and baths, front porches and back decks and no corridors, nursing stations or medicine carts.

Sounds familiar? It should! Small and medium sized RCFEs/ assisted living facilities have been using this model for many, many years at a fraction of the cost charged by nursing homes. And we take care of basically the same population, i.e. the frail elderly, those afflicted by Alzheimer’s and related dementia, incontinent, non-ambulatory, on hospice, etc. The difference? We are considered the social model for long-term care while a nursing home is considered the medical model. The line was fairly blurred before, but with these changes it almost disappears. I’ll be watching with excitement to see if the new Green House model will take hold and spread. If it does, it would be great because it would hopefully improve the image and reputation of nursing homes. Such an improvement would benefit RCFEs and assisted living facilities which suffer a certain loss of confidence and appeal on the part of consumers, due to guilt by association, i.e. being thought of just another type of nursing home.

4.4% or more. Here are some key findings:

The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011.

The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.

The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.

And here are the figures for San Diego.

Nursing Homes

Semi-private room:  Low – $187;  High – $295;  Average – $224.

Private room:  Low – $200;  High – $395;  Average: – $271.

Assisted Living Facilities

Base rate per month:  Low – $2,075;  High – $6,900;  Average – $4,031

Home Care Costs

Home Health Aid (hourly):  Low – $19;  High – $22;  Average – $21.

Homemaker (hourly):  Low – $19;  High – $22;  Average – $21.

Adult Day Services

Daily cost :  Low – $47;  High – $88;  Average – $75

On a personal note, for many of us operators of assisted living facilities in greater San Diego area, the last two years were not the best, not by a long shot.  At my facility – Evergreen Chalet – I had to lower the monthly rate to attract new residents. Even so, our occupancy rate was and still is at 75%. (licensed for 12 and only 9 residents). A good number of my colleague operators are in the same predicament. So when I see these high averages it is difficult for me to understand the dynamics of this market. Perhaps someone can explain it to me. I know only one thing; I am providing first rate care in a family-like setting, my caregivers are well trained and have their heart in the right place, our caregiver to resident ratio is extremely good and we constantly get compliments and praise from our residents and family members. So why are we not full? Ironically, many family members, nurses and other health professionals who come to us and see what we are doing, ask us the same question. Unfortunately, we have no answer

Here is my response to the posting.  Tell me what you think about the posting and my response to it.

I find Ken Dychtwald’s passion and knowledge of the senior’s buying power commendable. However, I am concerned with the possibility of over-commercializing the baby boomer issue. Even though my livelihood and the livelihood of hundreds of thousands of people depends on selling to the elderly, I am worried that we might get tunnel vision and concentrate our efforts only on selling (even if our products and services are newer, better, etc.). So I was encouraged to hear that Ken Dychtwald is also concerned with the “aging’s dark side,” like the dearth of geriatricians, insufficient funding to prevent diseases, and patchy long-term care services. These are certainly issues that need to be addressed. However, an even more important issue is left out or very little discussed: it has to do with how we, as a society and as individuals, treat our elderly. I have a feeling that if we would treat our elderly as they are treated in some of the other societies and cultures, i.e. with utmost respect (bordering on veneration), many of the “aging’s dark side” issues would be much easier to address, or could even become a non-issue. Am I wrong?

Perhaps you had a chance to participate in some of the activities prepared  by various organizations around the Falls Prevention Awarness Day – September 23, 2011. If not, don’t worry, you can still take advantage of the materials presented at some of these activities. I know of one interesting presentation, and if there is someone out there who knows about others, please share it with me and I’ll pass the info on my next blog.

The presentation I participated in was put up by the National Council on Aging and it was called Falls Prevention: Debunking the Myths of Falls in Older Adults. I enjoyed the presentation and now you can to.

Just go to  http://www.ncoa.org/calendar-of-events/2011-abs-webinars/falls-prevention-debunking.html

You will be able to download the presentation, listen to the recording and learn more about Falls Prevention Awarness Day. For us, in the assisted living/ residential care industry, this is a very important issue. The more we know the better we can protect our residents and ourselves.

If you are interested in this topic, you might want to read my two blogs on this subject:

http://www.evergreenchalet.com/2011/05/falls-assisted-living-facilities-part-1/

http://www.evergreenchalet.com/2011/05/falls-assisted-living-facilities-part-2/

The above paragraph was taken from website of the National Council on Aging (NCOA). Their One Away campaign put together a collection of 5,000 stories of struggling seniors and are asking lawmakers to sign the Pledge to Protect and Strengthen the Older Americans Act (OAA). The reauthorization of this Act is coming up soon, so now is time to ask our legislators to sign on.