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Cedar Community: Life the way is should be. The way you want it.

There is power in numbers! Consider the rapidly changing number of older adults in the United States and project ahead several years. The resulting changes in numbers is astronomical! For instance, by 2030 there will be over 74 million ‘Baby Boomers’ alive, well and retired living in the U.S. The fastest growing age demographic will be in the 85+ year old population growing from 5.7 million people in 2010 to over 19 million people in 2050!

In a recent survey, older adults were asked about the likelihood of them seeking to reside in a ‘senior retirement community’ after retirement. The survey results?
90% indicated that they plan on continuing to live in their same home, apartment, or condo after retirement. 10% planned to move to a retirement community of some sort. So . . . how will some of the obvious needs of older adults be met in the future? In their homes!

The older adult health care providers of the nation are rapidly changing their missions and business plans, adjusting to this reality. Instead of being an exclusive ‘institution’ based provider, many health care organizations are changing or adding services which bring health care and supportive care directly into the private homes of older adults! Again . . . “There is power in numbers!’

Health care providers are learning the vulnerability of their past strategy of observing and predicting the needs of older adults. Quality health care providers today have begun an ‘active listening’ strategy and going directly to the older adult to find what they actually demand for quality health care. The answer . . . “Bring it home!”

In light of this trend, a whole new world of options for older adults, in terms of home care is rapidly unfolding:

One concern for older adults is how to get home quickly as possible after a hospital stay (surgery)? It this possible? YES through sub-acute therapy care. Nursing homes, under Medicare, have focused not so much on getting older adults into the nursing home, but rather on how to get older adults out of the nursing home and back into their private homes which older adults prefer. Extensive rehabilitation programs are now available in a short term institutional setting. Average length of stay in a sub-acute setting is about 28 days!

What about rehabilitation (physical, occupational and speech therapy) being brought into the private home? YES this is available through ‘Home Health’ Agencies providing medical care! They also aid with bathing, medication monitoring, and basic minor medical procedures.

What about supportive assistance and/or ‘chore’ services being available in the private home? YES through Home Health Agencies help with basic care and chore services are available and may include assistance with shopping and housekeeping.

What about meeting the needs of older adults at their ‘end-of-life’ stage? YES there is a growing demand for hospice care providing medications, monitoring, pain management, and even spiritual direction to one facing death. In home hospice care is covered by Medicare and its a wonderful service and a service growing rapidly in demand.

What ‘new’ services might older adults be receiving in their homes? Many care provider organizations are considering programs known in the industry as “CCRC’s without Walls” [Continuing Care Retirement Community]. What does that mean? It means, in essence, being able to receive, at home, most all the benefits of living in a retirement community without actually living in a retirement community! For a relatively modest fee, the older adult living in their own home can receive services such as: Meals delivered, lawn care, snow removal, delivered groceries, house repairs, transportation, assist with finances and taxes, computer advice and repair, and even be a part of the sponsoring organizations activities, clubs and trips!

Cedar Community is one of the Top 100 not-for-profit Senior Care Retirement Community complexes in the United States. We get it! We will serve older adults in retirement communities and in their homes! Its what older adults want!

In the past several months, the U.S. Congress’ Government Accountability Office (GAO) and the Senate’s Special Committee on Aging have reviewed the financial viability of the nation’s CCRC’s (Retirement Communities that offer a range of living and health care options).

The cause for the study was concern over a few CCRC’s who declared bankruptcy and specifically the focus was on Erickson Retirement Communities, a developer of 20 CCRC’s in 10 states.

CCRCs vary in size, accommodations and services provided. They feature apartments or cottage homes and access to health care and a variety of other services, amenities, and activities. CCRCs provide housing and services for seniors who are independent; for those who need assisted living options; and skilled nursing care or rehabilitation therapy for those with more acute care needs.

To reside in a CCRC, seniors pay an entrance fee (usually atleast partially refundable, accept in most cases of those offering a ‘Life Care’ contract) and a monthly fee. Fee structures vary greatly depending on the setting, amenities, services, and special features provided by the sponsoring organization. Today there are approximately 1,900 CCRC’s in the United States. 82% of all CCRCs have a not-for-profit sponsor.

There are basically three types of Entrance Fee Contracts: 1) Life Care Contract (Most expensive and most intensive generally providing for on-site or accessible off-site assisted living and/or nursing care at no additional cost for the life of the resident); 2) Modified Contract (CCRC provides a limited amount of assisted living and/or nursing care services); or 3) Fee-for-Service Contract (resident receives a priority for assisted living and/or nursing care, but must pay the regular per diem rate paid by those admitted from outside the CCRC).

The government’s concern when a CCRC declares bankruptcy is with the resident and the ability of the sponsoring organization to provide the refundable portion of paid entrance fees. Many residents have a large portion of their personal assets involved with the entrance fee and have depended on the organization to provide for them as stated in their residency contracts.

While this concern is certainly real, I believe it must also be kept in context with understanding the broader picture of how well CCRCs actually perform as an industry. Recently speaking to this point is the CEO of AAHSA (American Association of Homes and Services for the Aging), the national organization of not-for-profit Retirement Communities. In an interview, on Friday August 13th, 2010 on the Fox Business Channel, AAHSA CEO, Larry Minnix was asked to discuss whether or not continuing care retirement communities (CCRC) should be considered a “risky investment” for seniors. Larry Minnix suggested CCRCs were a good fit for most seniors. He pointed out that:

• The financial success rate of CCRCs over the last 25 years is well above 95 percent.

• Many CCRCs provide financial aid to residents in financial distress.

• There are very few situations where residents have lost their entry fees if a CCRC fails.

Larry Minnix added in a recent blog the following:
“What bothers me about recent coverage, though, is that they focus on a very small number of problems at the expense of explaining how well seniors are served in these organizations. Despite a disastrous real estate market in the past couple of years, only one CCRC has said it cannot refund entry fees. The broader CCRC story is one of a high percentage of success. Few of the hundreds of thousands of residents of CCRCs have ever not received an entry fee that was owed them or their families. The truth is that the majority of CCRC residents and their families would tell you their story is one of satisfaction and security.
Though the GAO report counseled consumers to study CCRC contracts carefully (a very important idea), it did not recommend any federal oversight or action around CCRCs.
But all of the recent media coverage points up that CCRCs must continue to do a good job at being transparent, being fiscally responsible and being educators of current and future consumers, if people are going to understand the contributions that CCRCs make.”

The fact is that the majority of this nation’s CCRCs remain strong and financially viable. While feeling some of the affects of the down-turn in housing in the midst of a world-wide economic recession, CCRC occupancy has declined, but certainly not to the same degree as the general housing market. Future indicators and demographic projections are for a huge growth in the number of seniors in this nation, the outlook for current and future CCRCs is strong. CCRCs provide a unique function in society and one that will be viable well into the future!

Many of you still have memories of a doctor’s ‘house call’ to your home when you were sick and needed to stay in bed. How convenient it was when the kindly doctor showed up at your door. With medical bag in hand, a warm and friendly conversation ensued with assurances that your medical needs would be met and healthier days were certainly ahead. So very comforting and healing were those personalized visits right to your home.

Those days are certainly gone, right? After all, the medical system doesn’t allow for medical practitioners to drive around going from home to home! It doesn’t make financial sense and a doctor’s time is too valuable! But wait, maybe we all need to reconsider! Obviously the patient does benefit tremendously if not forced out of their home and comfort of their bed when recovering from illness or recuperating from a medical episode or trauma.

But wait . . there is an answer . . . its called Home Health Care!

With the referral from a physician, a qualified nurse can come to one’s home to provide a variety of medical care! Also available are therapists, case managers, supportive care certified nursing assistants, and even those aiding in spiritual needs of patients.

Doctors from hospitals and clinics are now referring their patients for Home Health Care services in greater and greater numbers. With Home Health Care, the patient continues to live at home and receive an array of professional nursing services and rehabilitation therapies.

Many Home Health Care Agencies also offer a hospice component providing comfort care and nursing assistance in the homes of people with a terminal medical diagnosis. Social workers and chaplain services are also a part of Home Health Care and Hospice services.

Everyday hospital and nursing home residents are being discharged ‘back home’ understanding the necessary additional nursing care is now available through Home Health Care agencies. I believe, to some extent, it is the result of patients receiving good institutional care and asking, “Could my nurse follow me home?” for further recuperative care. Through quality Home Health Care agencies the answer can basically be .. . ‘Yes, you can get nursing services in your home!’

Some patients being discharged from hospitals and nursing homes have other ‘non-medical’ needs. They are saying, “I don’t need nursing care, but what I would really like is to have someone give me some simple assists, like help with shopping or some light cleaning, could you do that?” The answer now is ‘YES!” As a separate operating division, most Home Health Care agencies provide ‘supportive care’ services. This is a non-medical program in which a whole menu of home ‘chore’ services are available! Supportive Care is generally available for all people of all ages. Services usually include:

 Personal care such as bathing, grooming, dressing, hair care, skin care
Escort and transportation for shopping and appointments
Meal planning and preparation
Laundry and light housekeeping
So, as you can see ‘house calls’ now come in the form of Home Health Care!