With a robust economy and an increasing interest by the private sector for the growing senior market, changes are occurring in options available for seniors and their families in the area of assisted living. These changes require the consumer, typically a Mom and her primary caregiver, an adult daughter, to be more educated buyers when considering assisted living. And, physicians, nurses, and discharge planners, who families depend upon for advice and education, need to be informed of these changes, they need to educate families, and they need to offer “the tips” below, in order to make quality decisions. This essay, as the opinion of one assisted living executive for the past twenty years, is intended to assist in that process.
Assisted living is not new in America anymore, nor is it new to the greater Northeast Ohio. There are literally dozens of long time, experienced assisted living providers in our region, with substantial experience in providing both hospitality services as well as long term care support services to their residents. And, generally speaking, these providers perform quite well as evidenced by any review of annual inspections of assisted living providers licensed by the Ohio Department of Health.
However, there are two new types of providers emerging into the field of assisted living who some would say lack the prerequisite working knowledge of the assisted living philosophy of service and long term care. First, Northeast Ohio is seeing real estate investment companies, often involved in multi-family housing, moving into the assisted living sector. And, secondly, many independent living communities for seniors, who have never been involved in delivering long term care support services to their independent living apartment residents, are applying for assisted living licensure or, of greater concern, are partnering with “in residence” home health agencies, and avoiding the regulatory standards of assisted living completely. Both types of businesses require careful scrutiny of their operations, their experience, and their approach to delivering long term care services before families commit to those facilities.
Assisted living is really health care. It’s not a real estate investment. With our strong current economy, assisted living facilities are now selling at the highest financial values in the history of this field and real estate developers are rushing into the market with what appears to be a strategy of “build them, fill them, and sell them” for a profit. Families need to be careful that the business interests of any provider are in alignment with the service and care needs of their loved ones and continue to align, over time. Families are seeking private, home-like apartments, supportive hospitality services, and quality, “hands on” personal care or behavioral supervision. And, they want the ability to “age in place” in their apartment, with more care provided over time as they age, and to avoid institutional care if at all possible. Finally, they want a provider who really gets to know Mom, her needs and preferences, and views her as a person who wants her independence, privacy, dignity, and right of choice protected. Does that align with “build them, fill them, and sell them?”
Secondly, independent living communities exclusively for seniors, many with strong capable histories of providing quality housing and hospitality services, like meals, housekeeping, activities, and the like, are experiencing market changes as well. Older people appear to be more interested in living at home longer or choosing patio home communities as an alternative to downsizing from a home of a lifetime rather than independent living apartments. And, with decreased demand, independent living communities are now providing “intermittent home care” in their independent living communities, occasionally by actually licensing as assisted living, but more so, by partnering with home health agencies and avoiding assisted living licensure regulatory standards altogether. In the latter case, families need to exercise extreme caution that their loved one’s care needs can be met with intermittent care only and they must recognize if an unscheduled care need arises, especially in the night, there literally may be no one in the building, other than neighbors, that can respond to their loved one’s need. What happens when memory care residents need care, or more importantly, need to be evacuated in the middle of the night?
So, families need to exercise caution when reviewing flashy web pages and who have aggressive sales people promoting cash discounts, undercutting pricing of long time established providers, and offering free moving expenses to get your loved one to “join their community.” Families need to take their time in researching the facility’s actual service and care experience with seniors of advanced age. They need to understand the Company’s interests in being a long time committed provider to their loved one they can count upon, or are they someone who intends to fill the place with older people and sell it to the highest buyer in three or four years.
Families do need to look for certain characteristics when shopping for assisted living. Families need to evaluate the resident living unit’s design to ensure it is “senior friendly” with the physical capabilities of seniors in mind. Take time to ensure that proper experienced staffing is in place, around the clock, and registered nurses are available immediately to assess a resident’s change in their health status. Families need to ensure that their loved one’s independence, privacy, dignity, and right of choice will always be respected in the care process and they are not viewed as “heads in beds”, a disparaging term that is part of the nomenclature for these developers. Most importantly, families need to be sure there is a long term commitment to be there for their loved one and their family rather than new, unknown owners arriving in the near future.
By: Timothy W. Coughlin
Mr. Coughlin is the Co-Owner of a major assisted living company in western Pennsylvania and the Greater Cleveland area for the past twenty years, he has worked in the field of home and community based care for older people for the past 40 years, and has sat on several state commissions throughout his career helping advance assisted living and community care public policy for seniors. He can be reached at: TimC@walsdc.com