Senior Living: it’s all about choice
Facilities reflect emphasis on independence

by Christopher Key

 

 

Many of us are old enough to remember when nursing homes, as they were then called, tended to be dank, gloomy, foul smelling places. You wouldn’t want to put your dog in there, let alone a human relative. All that has changed. Not only are today’s facilities clean, bright, and sweet smelling, they offer living choices that weren’t available as little as 10 years ago.

The realization that not everyone needs the same level of care has brought forth a proliferation of facilities, which can end up saving you quite a bit of money. This may be one of the few areas of health care that can make that claim.

Many facilities offer a range of services that don’t include close medical supervision. These are grouped under the heading of “assisted living.” Whatcom County offers a plethora of choices under this category. This is good news from several perspectives. Competition helps keep costs down, seniors or families can shop for the best deal, and there is a range of locations from which to choose.

Joel Hile, administrator of Orchard Park Assisted Living, defines the term “assisted living:”

“It is a place where you can live in comfort when you can no longer safely live alone; a place with nice furnishings, good food, and the privacy of your own apartment.”

One thing all the administrators agree on is that seniors and families shouldn’t wait until the last minute to choose a residence. Making choices under pressure is almost always a bad idea. There are a number of tools to help make these choices.

First are the facilities themselves. Most of them welcome inspections of their facilities and even urge you to come at lunchtime when it is the busiest. Play your cards right and you might even get a free lunch. Some will even provide you with checklists to help you determine what is the optimal choice.

Weiss Ratings, Inc., the only major ratings agency that doesn’t receive funds from the businesses it rates, offers a 47-page publication called Consumer Guide to Elder Care Choices. There are also some less comprehensive (and less expensive) materials available from the US Government Printing Office.

Hile’s facility, Orchard Park, opened in late 1997. Hile himself had extensive experience in running a psychiatric hospital.

“You might think that running an assisted living facility is easier than a psychiatric hospital,” Hile said, “but it’s not. That’s because of the range of choices we allow our residents.”

That ties into his philosophy for running the business.

“I want to try to give back to people who live here all that they have lost,” said Hile. “Most people who come here have lost so much: their friends, their spouses, their eyesight or hearing, their driver’s licenses, their homes, their possessions. We can help make up for some of those lost choices.”

Hile is well aware of the negative image mentioned earlier and wants his facility to be welcoming.

“I made a decision,” said Hile, “that no one would enter this building without being welcomed. We go out of our way not to say “no.” If we do, we always provide a good explanation. You want to put pictures on the wall? No problem. We allow pets. We want our residents to make their own decisions.”

Hile cites the example of one older woman who had just moved in from another facility. He was giving his standard orientation speech and she was looking out the window. Finally, he invited her to come to lunch if she wanted to.

“You mean I don’t have to?” she asked. That’s the kind of freedom Hile wants to preserve for the residents of Orchard Park. He also urged families who are considering assisted living for their elders to include Mom and Dad when making the decision.

There are generally 40-42 full and part time employees at Orchard Park, which grosses about two million dollars a year. It’s owned by a small Canadian company, Unicare Homes, that has several facilities north of the border but just one in this country. Hile appreciates the autonomy the company gives him in running the business.

“Our biggest challenge is meeting the demands of residents and families,” Hile said. “There is also the matter of decreased Medicaid reimbursements, which makes it hard for us to accept people dependent on that program.”

Recruiting and retaining good employees is always a challenge.

“This is not a high paying industry,” Hile said. “Many of our employees see it as a path to something else. I think we do as well or better than most at keeping employees. Some have been with us five years or more. I try to make it a fun place to work and keep stress levels down.”

Hile offered a piece of advice to baby boomers that was echoed by many of his colleagues.

“Get long term care insurance,” Hile said. “By the time the boomers reach the age of needing assisted living, it could well cost $5,000 a month or more.”

Lynden Manor also opened in 1997 and is locally owned. In addition to assisted living, it also offers independent living condominiums, a specialty care center for those with Alzheimers, and is located right next door to the Christian Care Center Nursing Home.

“We’re the largest such facility in Whatcom County,” said Ross Paterson, director of resident relations. “We have 110 assisted living units and 17 independent condos.”

Residents may be reluctant at first to accept the changes in their lives.

“Seventy five percent of the people who come here don’t want to live here at first,” Paterson said, “but they have needs that must be met. People are living longer and need more care. Families are working longer and can’t always provide as much care. We’re now at 100 percent occupancy and have a waiting list.”

There are a number of factors working in favor of Lynden Manor.

“Some people want to be out of the city,” Paterson said. “The cost of living here is lower.”

Speaking of costs, Paterson points out that the state could save money by paying for assisted living rather than nursing homes. In fact, the state has decreased payments for assisted living. Nursing homes get $150 a day while assisted living facilities get $50-70 a day depending on the level of service needed.

One truly bizarre regulation forbids families of patients on state aid from paying for extra services. I found this was so astounding that I confirmed it with other administrators before I would accept it.

Like many other businesses, Lynden Manor is challenged by increased costs for insurance. Rates have tripled over the past few years. Liability is very high for such facilities because of the risks of older residents injuring themselves.

“We always do a thorough assessment before residents move in,” Paterson said. “We want to make sure you can afford it. Basically, you’re paying for an apartment with services extra. Some don’t need the services but want the security.”

Like the other assisted living facilities, Lynden Manor tries to promote the independence of its residents. That includes a residents’ council, which meets without management present.

“We want this to be their home,” Paterson said. “When our residents leave, they can’t wait to get back here. Some people move here simply because of the food. The residents are our best salespeople.”

Lynden Manor employs 75 people, giving it a good staff to resident ratio.

“We try to insure that our staff can focus on what they do best, “ Paterson said. “We want our nurses to do nursing, our housekeeping staff to do housekeeping, and our kitchen staff to do food preparation. Everybody is happier if they’re not doubling up on tasks they’re not trained for.”

The challenges of keeping 110 residents happy are immense, but Paterson feels that the rewards of resident and family satisfaction are worth it.

Mark Robinson of Merrill Gardens at Cordata agrees that touching people’s lives is very rewarding. His facility is owned by a Seattle corporation that has become the second largest assisted living business in the nation. The R. D. Merrill Company was originally involved in the timber industry and opened their first assisted living facility in 1992 at Northgate in Seattle.

“I’m accountable to the corporation,” Robinson said, “but I’m allowed to run the facility like it’s my own business.”

Merrill Gardens is very much driven by providing their customers with choices. The Cordata facility also has a residents’ council.

“It’s important for residents to remain active in their own care,” said Robinson. “Our approach is person driven, not medical driven. The staff can advocate, but ultimately we’re guided by the needs of the residents.”

The medically driven model Robinson referred to is what he believes produced the unappealing conditions described earlier in this article.

“Stability is important to this corporation,” Robinson said. “Some companies tried to grow too fast and overbuilt.”

Merrill Gardens at Cordata has 99 residential units plus separate duplex and triplex cottages behind the main building.

“Assisted living is a challenge in this state,” Robinson said, “because of the high level of regulation. There are proposed regulations that will take choice away from the residents. It’s actually an effort to shift risk from the state onto the business. It seems like they’re trying to push us toward becoming nursing homes. That cuts down on choice.”

The fact is that nursing homes are doing some of what hospitals used to do. Assisted living facilities are doing some of what nursing homes used to do.

“All these regulations drive costs up,” Robinson said, “and the reimbursement rates from the state don’t come close to meeting costs. The result is that people end up in nursing homes when it would be far less expensive for the state to keep them here and pay us adequately.”

The 53 person staff at Merrill Gardens tries to meet the needs of the whole person in an environment that is social rather than medical.

Alderwood Park Convalescent Center in Bellingham is more like what most of us think of as a nursing home. It is locally owned and has 102 beds in three wings. Most of the permanent residents need more care than is available at assisted living facilities.

“Our expertise comes from the staff, not the corporation,” said administrator Carol Ann Andrews. “We do lots of education here and have a very knowledgeable staff.”

Alderwood Park is also feeling the pinch from decreasing state and federal funds along with the burden of regulation.

“We work hard to meet the regulations,” Andrews said, “and do our best to work with the regulators. The regulations that actually pertain to the quality of life and care get the highest priority. If you don’t do care right, you’re out of business.”

Part of the job involves caring for families as well as residents.

“We try to help families understand how to do things,” Andrews said. “Some of them may not have seen Mom and Dad for 10 years, but they expect us to do things right.”

The regulatory paperwork never ends.

“If the staff is doing paperwork, they’re not caring for others,” Andrews said. “We’re always looking over our shoulder. Every year, we’re fighting for dollars. Much of our job lies with educating the public, and that’s more energy diverted from care.”

So what’s the solution?

“Get us a decent funding stream that doesn’t have to be fought for every year,” Andrews said. “Get rid of red tape that doesn’t involve quality of care. If we could go back to a simple check off system of evaluation, the standards would be more objective.”

The old image of nursing homes is dying slowly.

“People who don’t visit nursing homes still hang onto that negative image,” Andrews said. “Older people actually have a more realistic image than younger ones.”

Many of the residents at Alderwood Park are not permanent. About 40 percent of their clients are in for short-term rehabilitation. Andrews agrees that the system is facing a major crisis as the boomer generation ages.

“Where is the money going to come from?” Andrews asked. “No new (skilled nursing) buildings have been built in this state since 1995. Facilities are closing in Seattle. There may be no place for people to go.”

Alderwood Park employs between 100-120 people full and part time with a payroll approaching $175,000 per month.

“You can’t let it get you down,” Andrews said. “You adapt slowly. I try to keep calm and don’t try to rush things.”

St. Francis Extended Health Care was founded by a local couple, Bob and Pat Hall, who built the present facility in 1985. A small private corporation, Touchmark Living Centers of Beaverton, Oregon, purchased the facility in 1999. Touchmark has 16 facilities in the northwest, most of which are high-end properties called Comprehensive Care Retirement Communities. The corporation prefers locating in mid-sized cities and wanted a presence in Bellingham. St. Francis is located right next to St. Joseph Hospital.

“It’s the best location in town for a business like this,” said administrator Tonja Myers. “The Halls were heartbroken at having to sell, but wanted what was best for the community. Touchmark can help keep us on the cutting edge.”

The primary focus at St. Francis is long-term care, but they also do short-term rehab for stroke patients and those undergoing radiation therapy. Physical, occupational, and speech therapy are among the services offered.

“We deal with a lot of end-of-life issues here,” Myers said, “so we’ve developed a close relationship with Whatcom Hospice. We also host a center for women’s health and rehab. That encompasses post-mastectomy care, pelvic pain, osteoporosis.”

There are nearly 200 full and part time employees at St. Francis for 120 licensed beds.

“We’re well-staffed here,” said Myers. “We tend to staff higher because our patients need more acute care.”

There is an in-house day care center for employee children, which encourages a lot of intergenerational activity.

“Our motto is ‘Excellence with the Personal Touch,’” Myers said. “It is the most patient-oriented company I have ever worked for. They’re interested in what’s happening with our customers and that’s very comfortable for me. Too much focus on the bottom line doesn’t work in this kind of business. Touchmark believes that if we provide good service, the money will follow.”

An indication of Myers’ confidence in the quality of care at St. Francis is that she would feel comfortable putting her own parents there.

“Seventy five percent of our patients fall under either Medicare or Medicaid,” Myers said, “and that’s our biggest challenge. Neither of those programs pays enough to meet costs. Increased regulations penalize while funding doesn’t match. Standards shouldn’t have to be lowered, funding should be raised. We not only have to do our jobs, but we have to fill out paperwork to prove we do our jobs. It’s frustrating.”

One of the things that helps Myers cope is the close-knit group of administrators in Bellingham. There is also a close relationship with St. Joseph.

“Our relationship with St. Joseph gives us access to HighNet, a computer intranet that connects health care providers,” Myers said. “Most facilities can’t afford a system like that.”

Is there a crisis coming for skilled nursing facilities?

“We haven’t seen a crisis in a couple of years, but there may be one coming about eight years down the road,” Myers said. “We’ve had to turn down admissions, but not often. We generally run 40-50 admissions and discharges a month.”

The ultimate solution to all the health care crises lies in communication, according to Myers. She points to the recent Health Care Access Summit.

“There’s no silver bullet,” Myers said, “but if anybody can solve the health care crisis, this community can. We must communicate, stay focused, and keep the patient at the center of the system. The solutions will come. If we do such a good job that regulations become redundant, then maybe the regulators will back off.”

These facilities represent just a fraction of what’s available in Whatcom County for senior citizens. Whether you need just a little help or intensive nursing care, the choices are there. What is not always available is the funding and that situation seems to be getting worse. The other common theme among the administrators we talked to is that some regulations actually interfere with patient care rather than improving it, by forcing workers to spend time completing paperwork, thereby limiting them time they can spend with patients.

The good news is that the facilities that are available don’t even remotely resemble that negative image we started with. They are clean, comfortable, welcoming and totally dedicated to helping residents maintain their independence. That’s very comforting to those of us who may end up there before too long.