Assisted Living Focus Changing from Hospitality to Aging in Place

According to Senior Housing News, the assisted living industry is changing from a hospitality-based model to one incorporating more health care options to allow seniors to "age in place."  

The shift in operational strategy comes as more seniors indicate a preference for assisted living to moving in with family members.  Whether seniors want to avoid becoming burdens to their children,  want to avoid loss of autonomy many seniors believe follows moving in with family, or simply want to avoid the practical, financial, and legal challenges cohabitation presents, older adults seem to increasingly view assisted living as a better option than moving in with family members.

The shift in operational strategy coincides with an industry-wide effort to improve quality of care. As reported here, a January GAO Report raised serious questions regarding whether CMS could properly oversee and regulate the quality of assisted living care, in what some called "a national scandal."  The industry has reportedly responded with efforts to improve, maintain, and demonstrate quality outcomes.  The Long Term Care Community Coalition (LTCCC) recently released its own report identifying key best practices and policies for assisted living facilities to regulate their own operations, and ensure the safety and dignity of residents. The report lays out guidelines and requirements for staff training including cross training across multiple subject areas, establishing licensing and certification requirements where appropriate, allowing for alternative training methods, and required training assessments, LTCCC Executive Director Richard Mollot told Senior Housing News.  

Although there is still both risk and uncertainty for consumers, there is great promise for seniors and their families if the industry shifts its focus to meet the objectives of seniors, while simultaneously tightening operational standards.  Regardless the short-term outcome, the recognition and incorporation of Aging in Place as a discreet objective means that the industry is seeking to meet the goals and objectives of seniors and their families, rather than simply achieving bureaucratically imposed requirements of a health care system concerned primarily with cost containment.  An industry leading the government is a welcome and promising possibility.         

You can read more here.

New Alzheimer’s Vaccine Could Cut Cases In Half

Scientists at the University of Texas, Southwestern have created a DNA vaccine for Alzheimer’s.

It’s thought that the formulation could decrease cases by half.

The vaccine utilizes DNA from Alzheimer’s proteins, from which the immune system learns to fight the compounds and prevent them from collecting in the brain.

The researchers believe human trials are finally in sight.

Dr. Roger Rosenberg, Director of the Alzheimer’s Disease Center at UTS (and also the organization’s founder), said the breakthrough is the result of many years of trial-and-error:

“[It’s] the culmination of a decade of research that has repeatedly demonstrated that this vaccine can effectively and safely target in animal models what we think may cause Alzheimer’s disease.”

According to the Alzheimer’s Association, every 65 seconds, someone in the U.S. develops the disease. 1 in 3 senior citizens die with it or another form of dementia. 5.7 million Americans currently suffer from the terrible condition, for which there are noted risk factors but very little treatment. By 2050, that number is expected to reach nearly 14 million.

Seniors with Dementia Abandoned by Family Caregivers at Hospitals and Homeless Shelters

Jeremy Jojola, investigative reporter for Denver KUSA/9NEWS, has published a heart-wrenching story uncovering a horrifying, but all-too-common, practice of family caregivers abandoning seniors suffering from dementia by abandoning, and stranding  seniors in public airports, malls, hotels, hospitals, homeless centers, and in at least one instance, a local McDonald's.  Jojola described the plight of 80-year- old Jerry Ellingsen, who suffers from Alzheimer's:

Within the bustle and organized chaos of Denver's massive airport, an 80-year-old man with Alzheimer's disease named Jerry Ellingsen was found wandering alone after traveling with his small dog from Fort Myers, Florida. 

Jerry didn’t know where he was or why he was in Denver.

A United Airlines supervisor found Jerry confused and alone, with only a small dog, near an exit door outside the ticket counter, and promptly called the police.  A police report indicated a flight attendant described Jerry as possibly suffering from Alzheimer’s.  One Denver police officer spoke with Jerry, and noted in his report:

“He was very confused about general details of his life to include where he was at, where he was coming from, who he was coming to visit and his family members’ names."

Police looked up the woman who checked him into his flight, and ended up talking to his daughter.  Police soon learned that Jerry's daughter, who was his agent under a Power of Attorney, put him on the one-way flight from Fort Myers, Florida.  She intended for Jerry to live with his estranged wife, but had texted the estranged wife only the day before with a simple notification that Jerry, and his dog "will arrive on a flight in Denver tomorrow afternoon."  The daughter made no other arrangements to transport her father, or communicate with her father's estranged wife, until sometime after he arrived, and then only texted the estranged wife, "[i]f you need to drop my dad at a homeless shelter, it’s fine. I just want him to have a roof over his head. Please." 

Jerry's family refused to rescue Jerry so police transported Jerry to University of Colorado Hospital. Laws require hospitals to admit and keep at-risk adults who’ve been abandoned until caseworkers can find safe placement for them, which can lead to extended stays for months and even years.

Jerry’s story sparked a 9Wants to Know investigation into at-risk adults who end up languishing in hospitals because they have no family to take care of them, or a facility willing to take them in due to a lack of space, finances, or appropriate scope of care.  The investigators conducted a point-in-time survey with the help of the Colorado Hospital Association because hospitals do not keep track of stays by people like Jerry.  Investigator Jojola described what the investigation discovered:

A three-month long 9Wants to Know investigation is uncovering a growing health care epidemic where hundreds of people like Jerry are abandoned every year at metro-area hospitals. The epidemic is costing hospitals and in some cases, taxpayers, millions of dollars a year.

Nineteen metro area hospitals participated in the survey, which revealed on a single day in September, 113 at-risk adults were stuck in the system, beyond medical necessity.  Of those patients, about 30 percent had mental health issues like Alzheimer's and dementia. Most of the stranded people were men over 40 years old.  The longest stay was 577 days!  

According to the article, Denver Health has a special wing called the "Oasis Unit" that houses around 30 at-risk adults on any given day. Denver Health reports it expected to spend $18 million on the Oasis Unit in 2018.  Anecdotally, Denver Health officials cited a case that resulted in a stay of eight years in the Oasis Unit.  Tax payers and consumers end up bearing the cost.  Hospitals in Colorado can cost up to $2,500 per day, per patient. 

A Knoxville television station also broadcast a report about Jerry's case.  Both reports indicated that charges were unlikely to be filed against and member of Jerry's family. The video broadcast identified the daughter's name, who, ironically worked for a health care agency specializing in providing health care for seniors.  

Instances of professional caregivers abandoning patients and residents are well-documented (see, for example, here, here, and, see here, what is hopefully an usual case in which professional caregivers abandoned a couple, who were then later abandoned by a privately paid professional caregiver who had worked for the first professional caregiver).  Family abandonment is less well understood and documented.

Given the stress and strain of caregiving, and the feelings of helplessness and abandonment that caregivers often feel, it is possible that caregivers simply surrender, leaving their vulnerable wards at risk.  Regardless, the only solution is advanced planning, including considerations of the demands and risks of caregiving, and the costs of same.  Greater education and support for caregivers from the community is also well past due.   

Nursing Home Compare Does not Accurately Reflect Patient Safety In Nursing Homes

The standard measure for capturing quality at nursing homes does not paint an accurate picture of patient safety, and changes are needed to aid residents in their decision making, reports an article in McKnight's Long-term Care News.

That’s according to a new study, published in the November issue of Health Affairs. Researchers took a closer look at data from the Certification and Survey Provider Enhanced Reporter (CASPER) and the Nursing Home Compare archives, aiming to see if star ratings accurately represented potential safety dangers at SNFs.  The researchers compared nursing homes’ performance in standard quality measures with six noted patient safety measures — including pressure sores, infections, falls and medication errors. They noted that the relationship was weak between the two measures, “leaving consumers who care about patient safety with little guidance.”

Changes must be made to give potential residents a better sense of the safety landscape, said Daniel Brauner, an associate professor in the Department of Medicine at the University of Chicago and lead author of the study.  “Nursing home compare should look more specifically at these safety measures because consumers are quite concerned about those things, for their loved ones,” he told McKnight’s. “The rating system should take these specific safety measures more seriously and make them a bigger part of its methodology.”

Results were gathered using data for the first quarter of 2017 from NHC and CASPER, representing more than 15,600 facilities. They found that, overall, performance on falls and urinary tract infections for long-stay residents, along with pressure sores for short-stay, showed “little meaningful difference” across star ratings. Meanwhile, medication errors and pressure sores for long-stay residents tracked more closely with star ratings, though with a weak correlation.

At Death's Door- Shedding Light on How to Live

Kaiser Health News recently published a story about Ronni Bennett, a  popular blogger who writes about aging, a blog aptly entitled "Time Goes By- What its Really Like to Get Old."   The story highlight's Ms. Bennet's decision to write openly about living with her own recent terminal diagnosis.

At Death’s Door, Shedding Light On How To Live explores the impact of a terminal diagnosis on how one person decides to live the rest of her life and how she is coping with the diagnosis. Her blog posts are illuminating, poignant, and of course, heart wrenching.  She lists the things she no longer does, like regularly exercising, or finds concerning:

All kinds of things... fall away at just about the exact moment the doctor says, “there is no treatment” (which is their common expression for “you're terminal.)”At least, that is true for me and one of those things that fell away is any concern at all about what any person thinks about me in any regard. How others identify me is not my concern.

She continues in another post:

"I live in a different country now – the land of the terminally ill.  

 Isn't that a horrible phrase, “terminally ill.” It's too clinical, even industrial. It ignores the humanity of the life that will be extinguished and it sounds so imminent, as if I am already on the first bus out of here - a bus being driven, of course, by the grim reaper, hood in place and scythe in hand.

But that's not true of me. For awhile anyway, I've got some time. None of the doctors and nurses knows exactly how long in my case but, given some chemotherapy, six to eight months before symptoms begin to kick in has been mentioned.

Me? I take the prediction with some caution. The time could be shorter or it could be longer and since there is nothing I can do to affect the timing, the only rational choice for me is to carry on living.

Without, however, losing sight of the impending exit date. To ignore it would be absurd.

On the day I learned of my new status, some decisions came to me immediately. I've mentioned giving up the daily workout I've always despised, and now I get to eat all the ice cream and cheeses – my two favorite foods – as I want."

Bennet's posts have found positive responses from readers.  Still, the Kaiser article acknowledges that others may not prefer to share their lives with strangers:

"Other people may have very different perspectives as they take stock of their lives upon learning they have a terminal illness. Some may not want to share their innermost thoughts and feelings; others may do so willingly or if they feel other people really want to listen."

The blog is insightful and compelling.  

I have never before mentioned in this blog another of my favorites, The Blog, by Rory Feek.  Rory's blog, too, concerns life, and coping with a terminal illness, but more profoundly, it is about love.  My  wife and I were fans of husband and wife country music artists Joey and Rory Feek from the first time we watched them on the CMT talent show "Can You Duet."  We have purchased every CD, and I have combed over every line of prose and poetry germinated and nurtured by their love- love of life, love for each other, love for their children, love for their family and friends, and love of God.  Like millions we wept when Joey lost her battle with cervical  cancer. 

My eyes still well with tears when I see the song, "When I'm Gone," in my playlist, and am reminded of Rory's testimony of the song's impact on his life in the blog post entitled, aptly, "when I'm gone:"  

Our ‘make-believe‘ song and video seems to be coming true.
Some call it ‘life imitating art’.  I don’t.
I call it God.
He knew I would need her to tell me goodbye… not just once, but a thousand times.  And I’d need to know that no matter how much time passes, that she loves me still.  And He made it so that if I needed to be reminded of her beautiful life and heart and voice… she would only be a ‘click’ away.

While there are likely no words uttered from human lips, or written by human hands, that can guide entirely any individual in his or her own meeting with mortality, it is both comforting and inspiring that others share their insights and wisdom.  The rest of the great mystery is perhaps the province of the divine.