Q: What should I focus on?

A: Here are five key areas: 

1) Increasing resident age and higher acuity — Many independent living communities are turning into “naturally occurring assisted living communities.” The need for assistance is increasing.

2) Aging physical plants — Physical plant retro t and cosmetic enhancement is a mandatory initiative for many campuses.

3) Increasing capital expenditure requirements — These investments can include functional design modi – cation, cosmetic enhancement and adding market-responsive features.

4) The expanding senior living and healthcare continuum — Many operators are specifically addressing Alzheimer’s/dementia, memory care and continuing care at home. They also recognize that the psychographics and “birthmarks” of prospects and their adult children/decision influencers have changed considerably.

5) Market positioning/ sales and marketing — Key strategies include sharpened marketing positioning, improving the lead management programs, and having very targeted and quantifed performance objectives and sophisticated social media strategies.

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX, that has been serving clients for 46 years. He has authored five books about senior living and healthcare, including Assisted Living Strategies for Changing Markets and Independent Living and CCRCs. Jim Moore can be reached at (817) 731-4266 or jimmoore@m-d-s.com.

What appealed to you about joining Ascension?

The intense focus on safety, quality of care and efficiency. Ascension recognizes that, in this new value-based environment, we not only have to do things with good quality, but we have to be cognizant of the costs associated with that care and do it as efficiently as possible. We have to be good stewards of the resources that we have. Ascension is working hard in its senior living communities to put the infrastructure in place to mitigate risk for adverse events.

I often use the analogy of the airline industry. What helps reduce errors in the airline industry is the use of checklists and protocols and algorithms. Not that it should replace critical thinking, but we know that, often, it’s the stuff that falls through the cracks, communication gaps that occur, that can give rise to trouble. We’re really intensely focused on how we can tighten up our processes to mitigate the risk of miscommunication and to ensure that appropriate protocols have been followed.

I use medications as an example because missed medications and medications adversely interacting with other medications or with supplements — those are the kind of things that we need to critically assess in our population. When a person comes to us in the skilled nursing or the long-term care setting or home settings, we want to make sure that important medicines are not neglected or forgotten.

Can you provide an example of the infrastructure changes you are talking about?

When I came on board, I recognized that we had certain issues related to star ratings for F-tags. Thinking as a physician, I look at those as signs and symptoms of a problem.

Studies clearly have shown that more important than the environment, more important than the food, more important than the programs, is having a consistent, competent, caring staff, because those relationships that are created are so important.

One of my big focuses right now is how we can eliminate staff turnover, how we recruit those good, competent people, and how we keep them and develop them. The key to the future to maintain quality and safety is going to be having that good, caring, competent staff.

Also, we’re going to start implementing the INTERACT (Interventions to Reduce Acute Care Transfers) program in our skilled nursing buildings, and implementing it robustly. Our teams are going to start their training in June.

We’re going to do the initial pilot in Waco, TX, at Providence Park, then plan on replicating in the other communities. Initially, we’ll focus on those skilled communities that are in geographic proximity to Ascension hospitals, so that we can really build that transition bridge.

We are going to be using the modified protocols for assisted living as well, concomitantly with the skilled. We’re going to tell the folks, “The assisted living population is not too dissimilar these days from the skilled population.”

Can you tell us how your role extends beyond the senior living portion of the company?

I’m also working with the Ascension Health group as the geriatric lead. Thinking as a geriatrician, thinking holistically, we really need to be evaluating older adults, as they leave the hospital, for things that are unrelated to the primary disease. We need to think about the cognitive and functional status of that person and think about the caregiver support that they have.

What often happens is, people get home and their families get stressed and anxious and don’t know what to do. The next thing you know, they’re back in the ER. It may have had nothing to do with clinical deterioration. It may have been just due to the stress of the caregiver. There are actually validated tools out there — one is called the Caregiver Strain Index, and the other is called the Preparedness for Caregiving Scale — that we can utilize to assess that.

These are some of the things that I’ve been discussing with my acute care colleagues that we need to be thinking about as we transition people from the acute care setting to post-acute and long-term care or to the home setting.

We’re also looking at advance care planning. One of the reasons that many folks are bouncing back and forth to the hospital, especially in the last few years of life, is that they’re often at the terminal phase of a disease trajectory. The average time in hospice hasn’t changed in 10 years. We’re waiting too long to be having these conversations.

Happily, the Centers for Medicare & Medicaid Services has now approved two new codes for physicians to engage in conversations around advance care planning. I think if people really understood the nature of their disease, the prognosis, that far fewer of them would elect to be subjected to some very burdensome and intrusive interventions. I think they would be more likely to choose a palliative or hospice care plan.

And are you still on the faculty at University of South Florida School of Aging Studies?

Yes. One of the thoughts I have is to go to the nursing schools and the certified nursing assistant programs and start educating them about the potential and the opportunity and the huge need that there is going to be in geriatric care and senior living. How how do we attract young men and women to careers in this field?

I’m trying to think outside the box. One of the thoughts I have is doing something along the idea of a co-op program like the one at Northeastern University in Boston. Students get paid to do onsite work with companies while they’re going through school, then the companies recruit some of the students.

Serious adverse drug events in nursing homes seem to have plateaued. Lengths of stay are even down. And efforts such as antibiotic stewardship have greater traction than ever before. But still, as Big Pharma continues cranking out powerful new drugs to treat maladies ranging from “nuisance” to “life-threatening” on the health scale, medication management remains a pressing matter.

“Expect 2017 to bring with it intense scrutiny of several classes of drugs, especially in the heavily regulated nursing home environment,” says William Vaughan RN, BSN, vice president of education and clinical affairs for Remedi SeniorCare. “While antipsychotics used for the treatment of behavioral and psychological symptoms of dementia will continue to be critically evaluated, antibiotics will also be high on the list of drugs attracting the attention of surveyors.” Vaughn also believes opioid prescribing “will also be put under the regulatory microscope as both federal and state governments create policies and enact legislation to address the related public health issues.”

Likely the biggest medication management challenge ahead is the so-called pharmacy “mega-rule” now underway in a three-phase rollout for long-term care that’s designed to infuse greater accountability to stem drug-related hospital readmissions and more transparency in dosing, prescribing and administration practices.

In the face of all these challenges, innovation marches mightily along as many eyes turn toward pharmacogenetics as one compelling solution to ensuring seniors not only take fewer meds but also take those most likely to fix what ails them in a very custom, personalized way.

Feeling the strain

The pressures seem to be coming from all sides.

For one, providers increasingly will feel the heat on controlled substances after years of abuse and neglect among prescribers, caregivers and the residents themselves. For example, prescription drug monitoring programs are either under development or fully implemented in many states, as Jennifer L. Hardesty, PharmD, FASCP, chief clinical officer and corporate compliance officer for Remedi SeniorCare, observes. The concept behind PDMPs is to create a single database repository to tightly monitor how, where and when those drugs are used in long-term care.

“With the increasing focus on overprescribing and diversion of controlled substances, the future may hold increasing challenges and operational hurdles for providing controlled substances in long-term care and assisted living settings,” she adds.

For another, medication management and reconciliation is a virtual necessity to comply with new rules about preventing and penalizing drug-related readmissions, says Brandi Apple, PharmD, C-MTM, a clinical consultant pharmacist at Guardian Pharmacy of the Piedmont, a member of the Guardian Pharmacy family.

Moreover, the nature of assisted living is evolving and changing under our very noses, making medication management a slippery slope. Even federal regulators are stymied about how to define it. “The assisted living/residential care industry is rapidly growing, and the types of residents many of these providers accept are clinically complex and medically fragile,” Hardesty asserts. “With the increased acuity and complexity comes the need for a pharmacy that will provide a true medication management system that benefits both the patient and the facility.”

“It should be noted that many states do not require medication management in assisted living facilities and other alternative care settings,” says Alan Rosenbloom, president of the Senior Care Pharmacy Coalition. “Unless the contract between the LTC pharmacy and the facility requires medication management, it simply isn’t provided.”

Many states also prohibit ALF staff from administering meds. And unlike their cousins on the skilled nursing side, ALFs aren’t yet under the same scrutiny about where their drugs originate, Rosenbloom adds. Although many have contractual agreements with one or two preferred long-term care pharmacies, ALF residents are free to use them “or any other pharmacy source they want — retail pharmacies in the local community, mail order pharmacies, etc.,” he says. This causes the manner in which such pharmacies interact with patients to vary widely from state to state. Moreover, retail pharmacies also aren’t under the same medication management rules as LTC pharmacies.

Meanwhile, more and more ALFs are reaping the benefits of evolving care and payment models such as accountable care organizations born under the Affordable Care Act. Doing so qualifies them to care for enrolled beneficiaries. Such partnerships also help ALFs at the expense of the SNFs because many patients bypass skilled facilities altogether, according to Rosenbloom. “Obviously, these trends create significant challenges for LTC pharmacies and also create opportunities,” he says. Still, “just because a patient who takes multiple prescriptions a day resides in an ALF rather than a SNF, that person still needs all of the consulting services LTC pharmacies provide.”

It remains unclear, however, that the ultimate payer will see the advantages of providing such services to patients in ALFs or other alternative settings and would be willing to provide “appropriate compensation to the pharmacies for those services,” he adds.

All told, these challenges are likely causing many ALF operators to lose sleep.

A complex challenge

Make no mistake: Medication management is as complex as any challenge senior living providers face today.

As recently as 2014, an inspector general report verified ADEs occur in 22% of all Medicare beneficiaries during their SNF stays; an additional 11% also experienced harm from those events. Meanwhile, nearly 60% of every one of those events were deemed “preventable.”

Other drug-related problems are lurking. The highly respected technology evaluator ECRI last November included two medication-related items in its top 10 list of healthcare’s greatest hazards in 2017: undetected opioid-induced respiratory depression, and mishaps linked to faulty user setups of automated drug dispensing cabinets.

A recent Journal of the American Geriatrics Society study titled “Older adults who take many medications have a higher risk for becoming frail” set the bar low: just five different daily meds as the minimum in its study cohort.

According to Rosenbloom, the average nursing home resident takes eight to nine prescription medications each day and takes between 12 and 13 different prescription medications over the course of a month.

When he’s not crisscrossing the country to consult with hospitals on physician management and staffing, Jerome Wilborn, M.D., national medical director of post acute care at Team Health (formerly IPC Healthcare), occasionally visits with patients. Weeks before this article was written, Wilborn visited with an 86-year-old hospitalized woman whose daily menu included a buffet of 28 different drugs.

“We treat our elderly with a very poor regimen of medications,” Wilborn says. “Part of the reason they’re sick is because we make them sick.” He doesn’t need any more confirmation that the industry suffers from a drug management problem. “I can go to any facility, and no matter how good my providers say they are, when I sit down with a director of nursing or unit clerk and ask them to give me five patients who are on more than 25 medications, every single time, one will quickly turn around and grab at least five charts,” he says. “You look at them and say, ‘Do you really think this makes a lot of sense? Let’s walk through each one.’ And in very short order, they will get rid of three to four meds on the first pass and feel comfortable. That’s all I’m trying to get them to do. Then I say, ‘Now go back and do it again in a couple of weeks.’ ”

As complex and challenging and interdisciplinary as medication management is, Wilborn can distill its parts down to one thing: medication optimization. It’s not only about just ensuring that the most appropriate drugs are being prescribed, but also ensuring they get to the resident in the first place.

“It’s not uncommon that medications you’ve prescribed aren’t being given, especially in places like assisted living, where there’s just a real paucity of caregivers, and sometimes those meds don’t get passed,” he observes.

Consider Selfhelp Community Services, whose nascent days 80 years ago were spent supporting Holocaust survivors seeking refuge in America and today offers a different kind of refuge online through its innovative Selfhelp Virtual Senior Center. The center evolved out of a request by the New York City Department of Aging to develop new kinds of technology-based services to help the area’s elderly cope with isolation.

Scott Code worked at the center developing the project before becoming associate director of the Center for Aging Services Technologies at LeadingAge. Seniors use the platform to connect with their other homebound peers. “In essence, using a simplified touch-screen computer and group video chat, you can ‘virtually’ bring homebound or isolated older adults together each day through engaging, volunteer-facilitated, discussion-based classes,” says Code.

The results literally changed lives. “It gave them purpose and meaning to their day,” adds Code, noting that the vast majority of participants now feel less hopeless about companionship, less isolated and disconnected from family and friends, and report a better quality of life.

“From a resident’s perspective, technology is facilitating entertainment, communications and social connectedness with friends, families and staff; enabling more resident engagement in care planning, self-management, including management of chronic conditions, and community activities; and supporting brain fitness, wellness, safety and independence,” says Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and CAST executive director.

So much of technology today flows up and down, left and right through the senior care continuum. Some innovation begins to fill a need among the aging in place community, as Selfhelp’s center did, and later is repurposed and at times improved in established elder living communities, and vice versa.

Years ago, before becoming chief operating officer for Affinity Living Group and professor, executive-in-residence and founding director of the Program in Senior Housing Administration at George Mason University, Andrew Carle worked with a team to develop the world’s first wearable elopement technology, with a tracking device embedded inside the sole of a shoe. The so-called GPS Smartsole allows individuals with Alzheimer’s at risk of wandering to be located within three feet, virtually anywhere in the world, and anytime they step outside of a preset Geozone, Carle says. Wearers easily can be checked and located via any internet-connected device or smartphone app.

“Here we are using an IT platform, satellites and cellular, and a wearable technology to address one of the major issues facing society,” Carle says. “Short of a cure, which is not imminent, we are looking at 20 million Americans with the disease by 2050, 60% of whom will wander and become lost at least once.”

Carle adds that the Smartsole is in more than 30 countries and “has documented saving lives while bringing relief to exhausted caregivers. Whether for those living at home or in senior housing, this is a technology that is making a difference.”

Nothing has transformed senior living more today than the electronic health record.

“Technology is improving timeliness, accuracy and completeness of documentation of resident information and care processes,” Alwan says. “It is enabling clinicians and caregivers to deliver more focused, and more effective, interventions, including preventive care; and, most importantly, measuring and improving care quality continuously. With interoperability and information exchange, technology allows care providers to engage with other providers in the healthcare eco-system, such as hospitals, physician offices, pharmacies, accountable care organizations and payers; and participate in shared care-planning and coordination to improve quality across provider settings and potentially reduce cost in share care and transitions of care situation. This is extremely important for referrals, especially in this day and age of pay for performance. On the other hand, technology is driving staff efficiencies, eliminating duplicated processes including data collection and entry, and engaging staff in ways that were not possible before.”

Then there’s mobile tech. Smartphones, tablets and other cellular-connected devices have streamlined care at the bedside and allowed seniors to stay connected with their families and friends in very powerful ways. “Mobile technology is allowing caregivers to do their job wherever they are and spend more time with residents at the same time,” says Charlie Mintz, director of business development for CareServ Technologies LLC. “Caregivers are already using mobile technology to access and document ADLs and care notes, get nurse call alerts, communicate via HIPAA-secure text messaging and make phone calls, all from a single device.” Smartphones, in fact, are allowing many providers to move away from “kiosks,” or wall-mounted or standalone stations, to check and upload information, making them vastly more efficient.

Cloud-based computing today has freed senior communities of the shackles and risks of physical servers, exponentially improving the security and seamless, rapid transmission of data. It also allows families and friends to connect with community residents using wireless methods such as cell phone and Wi-Fi.

Volumes have been written about the transformative powers of telemedicine, particularly in vast stretches of our rural landscape, and of remote sensors’ ability to prevent falls and elopement. Wearable tech has exploded in senior living, far exceeding even the most hyperbolic estimates when they were introduced a few years ago. Seniors today can wear unobtrusive pendants, bracelets or even passive embedded sensors in clothing to be tracked and located and that upload vital signs and other health data to cloud-based platforms and even EHRs. And as providers grapple with multiplying numbers of caregiver positions and fewer people to fill them, wearable tech promises untold efficiencies. Observers and developers say they’ve only scratched the surface of wearable tech’s benefits.

“Whether you’re living at home, a residential community, skilled nursing facility or another kind of senior living environment, combining the concept of the connected home with connected care is extremely powerful,” says Robert Venditti, director of research and development for Philips Lifeline, a medical alert solutions company. “There are devices today that can compile data and sense different aspects of engagement with the senior, whether passively or actively. When this information is connected to a back-end platform, the data can be processed to initiate a variety of actions, such as spawn alerts and notifications, or provide a dashboard showing the senior’s status to community workers or caregivers.”

Alan Bugos, head of technology and innovation at Philips Healthcare – Home Monitoring, sees a future in which Wi-Fi and Bluetooth surpass their cellular counterpart as the technologies powering connectivity inside senior living communities.

“With secure, reliable Wi-Fi connectivity throughout the entire community, more technology devices are now able to interoperate,” he says. 

Jeff Sands, managing principal at HJ Sims, characterizes the investor outlook as “cautiously optimistic” and says whatever rifts that appear now won’t serve as a discouragement to continued funding. However, “a reason for caution is a reaction to some of the news that has trickled out lately, such as Brookdale Senior Living’s problems and some of the concerns expressed by the REITs regarding the impact of the increase in new construction,” he says.

Other influencers, such as rising interest rates, potentially could have a cooling effect on investment, though Sands says he is not tremendously concerned.

“Even with some increase, rates are still at historic lows,” he says. “Many existing providers have already locked into their debt costs. Also, senior housing rents have historically tended to rise with rising interest rates, so it could actually be a positive for some providers.” The investment climate in seniors housing “has definitely shifted in the past 18 months,” notes Michael Hass, founding partner of Drive Development Partners. Lenders and investors, he says, are looking more closely at units mix, competition, demand, operators and the overall market.

“Whereas there was a bias to invest and build in 2015, now there is a slight bias against it,” Hass says. “More capital is taking a pass on projects that would have been viable in 2015 or 2016.”

Dague Retzlaff, senior vice president of Capital One Healthcare, sees a capital flow that continues to be strong “as investors on both the debt and equity sides seek higher returns that can be found in the more traditional commercial real estate asset classes.” And although market dynamics remain stable, Retzlaff concedes that “a rise in new construction in some submarkets has forced us as lenders to be a little more diligent in underwriting in those markets.”

The HUD machine

In the wake of the 2008 meltdown, the Department of Housing and Urban Development picked up the underwriting slack for seniors housing operators and has continued to be a stalwart in financing over the past nine years. Industry observers say they see no reason for HUD to cease its prolific output.

‘Stable’ option

“One of the selling points of HUD mortgage insurance is that it provides a stable, affordable source of capital when other sources exit the market,” says Anthony Luzzi, president of Sims Mortgage Funding. “We saw that during the credit crunch in 2008 and the recession that followed. However, despite the re-emergence of other capital sources, HUD continues to play an important role in the market. Their loan insurance programs provide long-term, fixed rate financing with full amortization and non-recourse provisions. Moreover, HUD is now able to accommodate more complicated financing and operating structures, giving it enhanced relevancy as a capital source.” 

Variables such as higher interest rates are still low by historical standards and should not pose any obstacles to HUD-insured funding, Luzzi says.

“Many of the HUD-insured loans for healthcare projects feature debt service coverage ratios considerably above HUD’s 1.45 minimum, because the capitalization rates used to determine value and loans have been higher than the interest rates used to calculate loans based on debt service coverage,” he says. “An increase in interest rates will result in a lower coverage ratio, but not necessarily lead to a reduction in loan sizing.”

To be sure, “HUD continues to play a major role in refinancing senior living, and ‘bridge to HUD’ programs have become very popular,” Sands says.

Michael Gehl, chief investment officer for HUD lender HHC Finance, expects the Federal Reserve to raise interest rates this year but doesn’t expect it have a huge impact. “I don’t see it as a big mover of activity in the market,” he says. “HUD borrowers typically want to lock in. Some might want to look at a floating rate, but I don’t see people racing into it, and it should not be a big concern.”

New money wants in

If the long-term care market is nearing the boiling point, it most likely could be from what Hass sees as “lots of ‘country club’ money from private investors wanting to get into the space.” There is “a dislocation between expectations on timing and the reality of a new senior housing project,” but new money simply seeks to enter the space without thought to consequence, he says.

New investors wanting to put money in long-term care doesn’t surprise David Friend, M.D., chief transformation officer and managing director in the BDO Center for Healthcare Excellence & Innovation.

“The demographics are overwhelming — especially for memory care,” he says. “Half of the people age 85 have some sort of dementia and with the aging of the population, that number will only continue to grow. Over the next 10 years, we will double the number of people with dementia who need an institutional bed. That is a powerful incentive to continue to build and renovate buildings for seniors.”

Friend believes that demand currently outstrips supply, so the market can absorb the projects in progress now and into the near future. If there is one exception, he says it is for upscale senior living communities. “If the market is frothy, it is in the high end, where there aren’t enough wealthy people to support it,” he points out.

One notable new player in the market from China, Cindat Capital Management, a Chinese investment firm focused on overseas properties, is reportedly seeking to spend $2 billion in seniors housing.

“China and other Asian companies see the U.S. market as an investment opportunity,” Gehl says. “It will be interesting to see what they do.”

Preferences changing

If there is a pronounced change in finance, it is that lender preferences for sector, project type and care mixes are evolving, Sands says. On the seniors housing side, the fastest-growing segment has been the construction of new independent living communities. On the skilled nursing side, he says there has been “tremendous consolidation occurring” and that banks have been “actively engaged” in lending in the sector.

Conversely, Sands maintains that healthcare REITs have “backed off of nursing homes over a concern about the impact of budgetary and regulatory matters” and that the void is being filled by private lenders.

“Private equity continues to raise capital and so they will continue in the game with an emphasis on development of new portfolios of multilevel senior housing,” he says. “The nonprofit companies that specialize in continuing care communities are active, and the municipal bond market has continued its appetite for this product.”

Likewise, Hass thinks private equity “still has cash to deploy, but they are, and have always been, discerning in their partnerships and project selection.” Even so, I feel like they still have a slight bias to invest,” he says.

The Trump factor

A new administration sometimes can have an impact on the industry, so how could President Trump influence the long-term care market? Views are fuzzy because it is so early in the Trump presidency, but overall the outlook appears positive.

“We are happy that a Trump administration is continuing to be as supportive of HUD’s mortgage insurance programs as previous administrations,” Luzzi says.

On the positive side for providers, Sands sees lower taxes, regulation reduction and un-cuffing of financial institutions. On the negative side, he says, restricting the flow of immigrants, Medicaid block grants and uncertainty over the repeal of ACA could hurt.”

More choice

Friend predicts that “mandates, regulations and subsidies will be replaced by choice, competition and actuarial soundness.”

Ultimately, Hass believes Trump will focus on the tax policy equation.

“If they adjust carried interest or reduce the corporate rate, it could lead to more capital investment,” he says. “What they do with healthcare, if anything, won’t deplete demand for senior care in 2022 and beyond. People will continue to age.”

The caregiver shortage could be exacerbated by deportations and the immigration ban, Hass says, but he adds, “Washington is a place where what happens is what’s most politically expedient, not what follows the loudest rhetoric.”

Heartis Village Peoria, which opened in December, is an $18 million new-construction community of 97,000 square feet, including a single-story, 36-unit memory care building and a three-story residential building offering 72 assisted living apartments. It is operated by Pathway Senior Living.

“We have done a lot in Texas and we wanted to expand into the Midwest with an operator who was interested in partnering with us,” says Eric Reiter, Caddis’ senior manager of development. “Based on our review on the demographics of the area, Peoria checked all the boxes of what we wanted to see — an underserved market that indicated strong demand. We knew our concept would work well, and so far there has been a great response by the marketplace.”

The assisted living component features luxury apartments in a mix of studio and one- and two-bedroom layouts. Amenities include a salon and spa with a therapeutic tub, two interior courtyards, a large dining room with adjacent commercial kitchen and a private dining room, theater room, library and computer room. The memory care units offer a studio layout with a private bathroom and direct access to dining and common areas. The building also is equipped with multiple therapy rooms, an activities center, sun room, salon and secured outdoor space.

Services include a 24-hour emergency call system, housekeeping and laundry services, personal transportation and daily living assistance.

Reiter served as the project leader during the planning phase and worked closely with the operator and contractor on developing a facility that would best serve everyone’s needs. Instead of putting forth a preconceived floor plan, Reiter based the design on the programs, activities and services the organization wanted to provide for residents. 

“This is definitely not cookie cutter,” he says. “We built it from the ground up especially for this market.”

The entryway and foyer create the “wow” factor for visitors, with stately wood columns and a vaulted ceiling, whereas the dining room windows allow plenty of sunlight to illuminate the interior during the day. Various public and private lounge areas allow residents to socialize or relax by themselves.

“Soaring spaces and wonderfully cozy areas are both important features,” Reiter says, “because it creates a sense of community and allows for privacy as well.”

The overall design style is what Jud Jacobs, Caddis’ executive vice president and partner, calls “prairie chic,” which features sharp vertical and horizontal lines, made famous by Illinois architect Frank Lloyd Wright and others. The village concept is a communal setting that focuses on wellness but is also set up to provide comfort and security as well, Jacobs says.

“It is a combination of design and quality of care,” he says. “We want residents to feel like this is their home and not an institution.”

Among the organization’s additional tech tips for members:

• Taking advantage of public Wi-Fi;
• using mobile devices and computers to stay updated about medications;
• reserving hotel rooms via mobile devices; and 
• dialing 9-1-1 for any emergency, as the call will go through.

The legislation, being called the American Health Care Act, would convert Medicaid financing to a capped allotment of federal funds to the states on a per-capita basis and would “fundamentally destroy the Medicaid program as we know it,” said LeadingAge President and CEO Katie Smith Sloan.

“Medicaid is the most important public source of financing for long-term services and supports,” she said. “This bill threatens our rapidly aging population with the loss of coverage for the health and long-term care seniors need. It is the wrong policy at the wrong time.”

Under the GOP plan, states that expanded their Medicaid programs under Obamacare would receive complete federal funding for them through Jan. 1, 2020. Monies then would be reduced for beneficiaries who had not enrolled in the program by then. States that did not expand their Medicaid programs would receive a fixed amount, $10 billion, over five years under the proposed legislation.

The AHCA bill also would permit health insurance companies to charge older adults who don’t yet qualify for Medicare up to five times as much as they charge younger ones for coverage. The ratio under the ACA, by comparison, is 3:1.

Paraprofessional Healthcare Institute President Jodi M. Sturgeon cited a new PHI study, published Tuesday, that found that 500,000 direct care workers — personal care aides, nursing assistants and home health aides — gained coverage under the Affordable Care Act, primarily through the expansion of state Medicaid programs.

“Plans to cut Medicaid spending at the federal level will adversely affect these workers as well as their clients: older Americans and people with disabilities,” she said. “Per-capita caps on spending will reduce funding for long-term services and supports in home and community-based settings and across America’s nursing homes. More than one-third of Medicaid spending goes to support these services.”

Many assisted living communities provide home- and community-based services to their residents through Medicaid waivers.

Caregivers who don’t have health coverage would be more likely to miss work or leave the caregiver workforce, Sturgeon said. “With unprecedented workforce shortages already affecting long-term care, we cannot afford to take away the health benefits that are so crucial to recruiting and retaining these workers,” she said. (See the sidebar for additional information about the PHI study.)

Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, also expressed concern about potential Medicaid cuts.

“The bill …  will sharply reduce Medicaid funds across the board for all beneficiaries, making it harder than ever to maintain access to care for the most vulnerable in our society,” he said.

AHCA/NCAL, Parkinson said, “strongly encourage Congress to protect Medicaid access for seniors and people with disabilities in the Obamacare repeal-and-replace effort.”