“When we began in 2007, there was a surge of seniors in the area, so we did a tremendous amount of planning with the neighborhood and town,” says Sister Kay Ryan, who serves on the executive team with Sister Lauren
VanDermark. “Everybody was looking at the needs of the area and how we could meet those needs. We envisioned that this would be a great middle income housing community with amenities and services.”

The economic collapse of 2008 threatened to put the project on hold, but the team put together an incremental construction plan that kept Shaker Pointe on course. 

“Our original finance plan was always intended to be a $50-$55 million project and after the meltdown, we carved it off and got financing for each phase,” Ryan says. “Financing was a combination of regular construction loans and, as entrance fees came in, bond financing for the long-term debt. The planning was right on target with the construction timetable and we always met the timeline.”

The first phase consisted of building cottages and attached four-unit homes; the second phase included a 15-unit apartment building and one-story connected homes; and the third phase, completed in May, is the main structure with a community center and two adjoining wings. The three phases together add up to 162 residences.

Shaker Pointe’s community space, The Pointe, includes a fitness center, pool, meditation room, activities studio, dining room, bistro, country store, barber shop, salon, massage room, library, in-house primary care physician clinic and a restaurant that’s open to the public five days a week. 

Several of the amenities are available for public use, in fact. The fitness center, pool and physician clinic all welcome visitors, which is in keeping with Shaker tradition, Ryan says.

“The Shakers are known for community connectivity and it is that connection within community and neighborhood which resonates with our mission of life enhancement,” she says.

The great room, a wide-open space with seating designed for meetings and recreation, is modeled after the Shaker communal buildings. Because Watervliet is one of the largest Shaker settlements in the Northeast, using designs based on their Dutch sensibilities made sense, Ryan said.

“The architecture of the Shakers is in line with what we wanted — efficient, classic and resourceful for the generations coming behind us,” she said. 

3 Lessons Learned:

1 Major building projects can be completed in phases if economic conditions weaken or funding becomes difficult.

2 Adopting a theme specific to the heritage of a geographic region or culture is a unique and marketable concept.

3 Allowing public access to certain amenities is a good way to boost relations with members of the community.

As various outlets have reported, new research warns that more than 2.5 million more eldercare workers will be needed in the next 15 years. For the study, University of California at San Francisco investigators took a long, hard look at usage trends, and matched them against several possible future scenarios. In each instance, it was clear that demand would far outstrip supply.

“Filling these jobs will be a big challenge,” said Joanne Spetz, Ph.D., the study’s lead author. 

And it’s not like existing levels are robust. In fact, things are getting so dicey that a lawsuit against one of the field’s largest chains alleging inadequate staffing was awarded class-action lawsuit status.

When many operators hear these kinds of stories, their thoughts turn to finding new labor supplies. Which, in a way, completely misses the point.

Yes, the numbers are troubling. But what’s even more disturbing are the reasons driving them. Simply put, many of the caregivers in this field have had it. They are tired of the long hours, lousy benefits, extra duty, being taken for granted — and wondering whether they really make a difference. 

So what’s to be done? There are some obvious answers. One is offer better pay and benefits. A second is to better staff communities. A third is to make them less dangerous and unhealthy places to work. And finally, a little more sincere recognition wouldn’t hurt.

None of these options is a silver bullet. And they all can be a waste of time if operators fail to appreciate how hard the work in this field can be.

As a general rule, happy employees don’t up and leave. When they do, it’s usually because they found a better deal elsewhere, the current situation has become unbearable, or both. 

Whenever an employee departs, a point is being made. But if all you see is an open spot to be filled, there really has been a failure to communicate.

While the act of wandering isn’t always dangerous for the resident, if it’s not done in a safe and controlled environment, it can lead to falls, elopement or even death. In May, an 86-year-old assisted living resident in Maryland with dementia wandered from his facility into the street, and died after being struck by a car. Such devastating events are hardly isolated; however, experts agree they can largely be prevented with a comprehensive resident safety plan.

“Taking measures to improve safety can prevent injuries and help a person with dementia feel more relaxed, less overwhelmed and maintain his or her independence longer,” the Alzheimer’s Association notes.

Assisted living operators are heeding that advice. Many are designing thoughtful indoor and outdoor spaces that encourage safe wandering. They’re also engaging in ongoing staff education to help identify at-risk residents, and developing individualized care plans to reduce the risk of dangerous wandering, falls and elopement. As an added layer of protection, operators are employing modern, discreet and unobtrusive wander management solutions that let residents roam safely, promote autonomy, and promptly alert staff to falls, elopement, behavioral changes, or other events.

“The promise of technology is in preventing bad things from happening and/or facilitating the appropriate response if an emergency occurs,” says Mike MacLeod, president and co-founder of Status Solutions LLC.

Hidden helpers

Gone are the days where wander management requires loud alarms and institutional door lock-downs. Today’s innovative solutions may include low-profile door controllers with discreet keypads that seamlessly blend with the residential setting, and resident-worn bands, pendants and tags that can be set and adjusted to meet resident’s unique and evolving needs. 

“We believe if you enter a dementia care area with wander management and you notice the emergency call system, whether it’s audio with buzzers or alarm announcements, or visual with flashing lights and such, the system is outdated,” notes CISCOR CEO Sam Youngwirth. “Systems should blend into the environment and should not induce stress to the resident.”

A basic, intelligent wander management solution will include a transmitter for the resident to wear, and sensors at each of the doors to sound an alarm when the monitored resident approaches. Entry-level systems won’t do much beyond sounding the alarm, and possibly locking the door preventing the resident from eloping, points out Laurence Yudkovitch, product manager for RF Technologies. 

“While this satisfies the basic requirements for protecting at-risk residents, it does so at the expense of adding noise to the environment, and still requires a caregiver to be within earshot of the alarm.” Smarter, integrated solutions include remote alerting capabilities, allowing the caregivers to be anywhere in the facility and receive a page, SMS or email if a monitored resident elopes. “By reducing or eliminating the audio alarm, these systems improve the ambience of the facility, decrease disruption to other residents and free up caregivers to perform other activities,” 

Yudkovitch notes, adding that aesthetics are also part of modern-day wander management solution design.  RF Technologies’ Touch Pad Exit (TEC) controller turns off the backlight when not in use, so it blends into the background and helps promote the home-like feeling. Similarly, facilities can forgo the bulky black transmitters residents wore in the past and opt instead for discreet, lightweight transmitters that are as comfortable as a wrist watch and feature calming, colorful designs. 

Many of the latest wander management solutions also integrate with other resident security systems, such as emergency call, security and fire panels, telemetry, access control, mobile alerting and reporting systems, closed circuit televisions, and more. 

“The ability to integrate these systems has gotten easier over the last few years. Oftentimes, there can be significant savings by integrating these systems via comprehensive technology design that takes into consideration how care staff interact with all of the systems,” notes Wes Columbia, technology studio lead for Direct Supply Aptura. 

Enhanced integration and interoperability makes it easier than ever for staff to monitor alarms and security events, and then use that data to pinpoint resident patterns and provide more flexible, individualized care.

“As an industry, we’re moving from a reactive mentality to a much more proactive one of trying to get in front of an incident using predictive technologies,” says Youngwirth. “We know that when a resident deviates from their norm, the probability of an incident can increase.” 

CISCOR’s system helps caregivers learn individual resident patterns and sends an alert when a resident deviates from his or her norm. This allows caregivers to intervene before an event occurs.

Customized alerts are also paramount to providing personalized resident care and response. As part of the Code Alert Wander Management system offered by RF Technologies, model T80 TEC can uniquely identify each monitored resident at the door. Aside from allowing customized alerts that inform the caregiver which resident is loitering or eloping, advanced analytic capabilities in the software let caregivers track and trend resident behavior over time. This information can be used to detect changes in a resident’s condition, and help determine alternate care plans, according to Yudkovitch. 

“If a resident starts generating a number of loiter alarms consistently over a couple of days, for example, that can serve as advanced warning that the resident may be at a higher risk for eloping, and trigger the staff to create an alternate program to re-engage the resident,” he says.

Video enhancements add another level of specificity to alerts. A facility can use video paging to visualize door alarms to prevent elopement, notes MacLeod. 

“Sometimes, residents with wander-prevention bracelets can trigger an alarm because they’re in the general vicinity of the door, not because they are trying to walk out,” he says. “If staff can see that a false trigger has occurred, they don’t have to deploy resources to investigate.”

Giving caregivers ready access to real-time, resident-specific information from their smart technology — anywhere and at any time — enhances staff response that results in better resident care. 

“Care operators can assess, predict and report any incident from one central location, or from anywhere in the facility,” says Jack Zhang, CEO of CaerVision Global Inc. “With facial recognition, voice activation and wearable devices, senior living organizations can remain confident that residents will not [engage in unsafe wandering].” 

CaerVision recently acquired Vitall Inc., a provider of resident safety and monitoring technology. Vitall’s wearable, in-room monitoring solutions provide round-the-clock emergency support from a centralized facility. The technology controls security access/entry, intelligent environmental controls for lighting and room temperature, CCTV, data/voice communication cabling, datacenter management, wireless infrastructure, and audio-visual controls.

Expanding the reach

Wander management solution providers also are taking advantage of increasingly budget-friendly and reliable real-time location systems that can be used both indoors and outdoors. In some cases, the technology offers an alternative to obtrusive door locking and anti-elopement systems, which can have visually or auditorally disruptive alarms. 

“An effective RTLS solution, while allowing residents the freedom to move freely throughout a facility, can ensure residents’ safety by providing detailed — and often quiet — real-time scenario notifications that are distributed to conveniently located staff and/or nurse stations,” says Rachel Owens, VP of product management for PointRF. “This enables situations such as an unsafe area entry to be addressed quickly, before an event occurs.”

Add-on accessories can further enhance the data generated by an RTLS solution. Internal pedometers and accelerometers in wandering bands that are part of a building-wide RTLS, such as the PointRF NoWander platform, can provide ambulation trend information. This can play a role in fall risk management and therapy needs assessments, according to Owens. 

However advanced today’s wander management solutions may be, experts agree that their benefits won’t be realized if staff aren’t doing their part. The bottom line, the experts concur, is that staff must be committed to analyzing captured data to drive improvements and provide the most appropriate, resident-centric care. 

“If a resident has a propensity to ‘go home after work’ as the sun is going down — a common issue for many residents — staff can use that information to structure activities during the time following dinner,” says Columbia. This allows the resident to stay active and engaged while reducing the risk of elopement. 

Staff must also understand that technology can’t do its job effectively without human intervention. 

“What if the batteries on the resident’s device fail? What if [the resident] gets out the door with a visitor? What if they ‘crack the code’? These are things to consider,” reminds Eric Masters, VP of marketing for Relias Learning. 

He also points out that staff should rely on their training to determine who is at risk for elopement or wandering to another section of the building, and what they must do to help return a resident to their designated area. 

“Education and awareness, as well as adherence to company policy and manufacturer instructions on technology upkeep and maintenance, may be even more important than the technology itself,” he adds.

At least 1 in 3 eldercare residents experience some degree of incontinence, according to national nursing home survey statistics from the U.S. Department of Health and Human Services.

If not managed properly, it can cause even bigger problems, such as skin breakdown, subsequent infection or increased fall risk. 

These risks ensure that incontinence management remains a top challenge for long-term care operators. Aside from staff shortages and residents’ tendency to try to hide their condition from family, friends and caregivers, lack of understanding about incontinence care also contributes greatly to the problem. 

Caregivers might view incontinence as a normal part of the aging process and assume that once a person becomes incontinent, it cannot be reversed. 

It’s an unfortunate misunderstanding that experts say leaves staff focusing solely on managing moisture exposure, rather than working to treat and proactively manage the cause of incontinence. 

“Changing the negative stigma requires a holistic approach to reducing episodes of incontinence. This can be achieved by increasing residents’ and care providers’ awareness of the topic of continence management,” says Amin Setoodeh, RN, BSN, BS, vice president of clinical services at Medline Industries. 

Delving deeper

Effective incontinence management requires a facility-wide and evidence-based approach, experts emphasize. 

Investigating the cause of incontinence for each resident and diagnosing the type is necessary to determine if the incontinence is treatable and reversible, experts note. This approach helps because many incontinent individuals may be uncomfortable bringing up the topic with clinical staff, says Alex Sargeant of Hartmann USA. 

To catch incontinence episodes early, he recommends caregivers take the lead by inquiring daily whether the resident has noticed any wetness on his or her clothes or sheets. If so, asking whether this has affected any activities and daily routines, such as engaging in social events or meals, will help staff determine the best treatment or management approach. 

“By continuing to engage individuals about how they are doing in this regard, both caregiver and resident become more comfortable talking about it,” Sargeant says. 

All departments should be involved in incontinence management, including housekeeping, maintenance, dietary, activities, therapy, social services and nursing. Each has a valuable role, stresses Betsy Meyers, vice president of Midwest sales for Gentell. This includes activities staff, who can schedule programming that accommodates toileting schedules; social services, who can  address resident self-esteem and family support; and therapy staff who can supply assistive devices and strength training or transfer skills for residents. 

Another important department is dietary, which can provide adequate fluids and nutritional support for healthy skin integrity or repair, and bladder and bowel health. The maintenance staff can advise on lighting and mattresses, and housekeeping/laundry employees should be encouraged to identify residents who become incontinent. Finally, certified nursing assistants are often on the front lines of toileting and skin maintenance, and can assist nurses with skin treatments.

“We must promote continence rather than encourage dependency,” says Setoodeh. “Each care provider, resident and family member should learn more about different types of incontinence, the cause and the available treatment options. If the goal is optimal health, everyone needs to work together to implement an individualized care plan.”

By doing routine bowel and bladder assessments — upon admission and then on an ongoing basis — incontinence can be managed proactively. 

Focus on flexibility

Every resident has different continence needs and preferences, so operators must adopt a flexible approach, experts emphasize. For Levindale Hebrew Geriatric Center and Hospital in Baltimore, this means ongoing communication among staff and residents, daily monitoring and logging of resident toileting practices, and hourly rounding to cue residents and prevent avoidable accidents. Those who void more often get even more frequent caregiver visits. 

“This is helpful because we may have just rounded, but then a resident may go minutes later,” explains Gloria Blackmon, BSN, RN-BC, director of nursing for long-term care at Levindale. “When we have these individualized plans, we can flex staff to keep up with frequent rounding and prevent someone from having to wait until the next hourly round.”

Having a good grasp on residents’ activity and bedtime schedules also contributes to a successful continence program at Levindale. This allows staff to tailor hydration, toileting cues and even diuretic administration around each resident’s needs. 

If a resident attends a particular activity each day or week, caregivers can work with dietary staff to ensure fluids are offered earlier in the day, or after they return from their function. Staff may cue them to use the restroom before their activity. 

Night owls may benefit from taking diuretics later in the day because they’ll be awake in their room anyway, which can make toileting easier and not impede their participation in other activities offered throughout the day, points out Blackmon. Nursing assistants are the best research detectives. 

“They know the residents and their routines well and it’s important to rely on their knowledge,” she says.

Activities staff and therapists also should be flexible with their programming, allowing for restroom breaks to accommodate all residents — not just those known to be incontinent.

“They should also remind [residents] of the nearest restroom,” stresses Blackmon.

The right products

There’s a plethora of advanced incontinence products on the market today that can simplify the care process, boost resident confidence, improve skin health, and help remove the negative stigma surrounding incontinence. 

“It’s important to establish a guideline for selection of the most appropriate absorbent disposable continence management product that promotes containment and dignity for each resident, based on [the resident’s] assessment,” says Setoodeh. 

Cleansing with a pH-balanced   cleanser is also vital. Unfortunately, many caregivers skip this step in favor of plain soap and water. Because most soaps are alkaline, their use for incontinence cleansing may impair the skin’s protective acid mantle and inadvertently promote skin irritation or breakdown in incontinent residents, says Elaine McGowan, BSN, RN, CWCN, DAPWCA, vice president of clinical affairs for DermaRite Industries. 

Caregivers also may mistakenly believe that simply changing the incontinence brief is sufficient if the episode of urinary continence is considered minor. 

“This leaves potentially irritating urine residue on the skin,” McGowan stresses. 

For best results, a skin protectant or barrier containing dimethicone or petrolatum should be applied. This should be done without fail after every incontinence episode, explains Beth Young, BSN, RN, CIC, clinical consultant for GOJO Industries Inc.

PC&S, which is a faith-based, nonprofit organization, asked me to create a leadership program for them that we later named Leadership That Matters: Equipping Exemplary Leaders (LTM). 

I am excited to help spread my knowledge of the program and educate others on the importance of developing successful leaders for this industry.

PC&S is implementing LTM at the director level across all of their communities — the content is applicable for leaders in any environment. PC&S has two continuing care retirement communities: Presbyterian Village North and Grace Presbyterian Village (which offer independent living, assisted living, long-term care, skilled nursing and memory care) and also a hospice organization: Faith Presbyterian Hospice. 

Leadership That Matters is a rigorous, practice-based program that spans 12 months. It’s designed to allow new leadership skills and capabilities to really sink in. 

LTM is divided into three sections: Self, Others and Organization. 

With the intent to share an immediately applicable model with the industry, I recently gave an overview of the program and taught a core element of the content at the NADONA and LeadingAge conferences in April and May. 

In my presentation, we covered the two central models: The Drama Triangle and The Empowerment Dynamic. Many people get pulled into what “The Power of TED” author David Emerald refers to as “The Drama Triangle,” in which people react to problems by rescuing, blaming and falling into the role of a victim. 

The goal is to shift from The Drama Triangle into The Empowerment Dynamic (TED). With TED, people focus on the positive and sustainable outcomes they would like to achieve. They then coach others and themselves, challenging all to reach their goals. Effective leaders are able to remove themselves from the drama of a situation and shift to a more empowering mindset. Leaders at both workshops commented on the usefulness of the models, particularly in having a way to get out of the drama!

LeeAnn Mallory is a leadership and organizational development consultant for Presbyterian Communities and Services.

Getting maximum return for the amount invested is the goal and there are various ways to achieve that end, whether it’s acquiring high-quality items at a discounted price, shaving per-unit costs by buying in bulk or by purchasing durable materials that pay off in the long term. It depends on the facility’s needs, priorities and opportunities.

Beyond price

The main difference between a “cheap price” and “good value” is that “cheap deals are exactly what they seem — too good to be true,” says Jennifer Michalski, assistant manager of national accounts for C/S Eldercare Interiors. 

“Good value comes from long-lasting products that can stand the test of time both physically and visually and that can be easily maintained in case something happens. Price can be a driver in the decision-making process, but quality and durability will weigh heavily on the final decision. Most facilities and designers will pay a little bit more for a product that will stand the test of time.”

As a maker of privacy curtains and wall and door protection products, C/S’s products are designed to provide the proper balance between aesthetic appeal and product durability, Michalski says.

“Gone are the days of ‘function over form,’” she says. “Although most facilities will agree that durability is the most important factor when choosing an architectural product, residents want to feel at ease with the help of calming designs.”

When purchasing new furnishings and fixtures, facility managers should always keep the well-being of residents in mind, Michalski says. 

“Human beings are naturally inclined to invest their emotions in their surroundings, so it is important to make residents feel at home in a comfortable and reassuring environment,” she says. 

Ridley Kinsey, director of healthcare retail markets for Patcraft flooring says while some customers are looking for the lowest price, “lowest price does not necessarily equal lowest cost.” Instead, he maintains that customers should base decisions “total cost of ownership” or “lifecycle cost,” which gives a return on investment over time. 

Value purchasing 

Cooltree is one example of a vendor striving to be in tune with the senior living market’s specific dynamics, so much so it focuses exclusively on that customer base. Kimberly Calimeri, inside sales coordinator, says the maker of case goods and chairs adheres to a value-conscious philosophy in its sales approach.

“We offer the most we can give per dollar,” she says. “It all comes down to construction, materials and hardware we use.”

The company stands for “quality, warranty and innovation” in its product lines, Calimeri says, pointing to a standard 10-year warranty to back up the quality of materials, construction and durability. For case goods, high-pressure laminate is a higher caliber material than thermally infused laminate, resisting nicks, scratches and dents. Five-piece construction is designed to put less stress on drawer dowels to keep them from coming loose. Chairs have steel frames with wood grain finishes and have antimicrobial properties to reduce pathogen transmission.

“These are all key features that customers appreciate and what brings the best value to each purchase,” Calimeri says.

Environmental emphasis

Saving the earth and saving money aren’t mutually exclusive, says Lucas Hamilton, manager of building science applications for CertainTeed Ceilings. Energy efficiency and sustainability — with a growing focus on product transparency — have been key demands from customers, he says.

“Over the past decade, green building certification programs have motivated building product companies to become better environmental stewards by making their material content and manufacturing processes more sustainable and transparent,” Hamilton says. “Documents such as Environmental Product Declarations and Health Product Declarations are important to the industry because they provide access to manufacturer information that is uniform and simplified, informing facility managers about the products they select and their impact on human and environmental health.”

Ceilings and walls are critical components of room design and at the forefront of environmental breakthroughs, notes Hamilton, whose company recently introduced its Ecophon Advantage line of fiberglass applications. The intent is to provide an environment of “pleasing” acoustics as well as optimal indoor air quality, he says.

“The overarching goal of an assisted living facility is to provide a pleasant, healing environment for residents, maximizing their comfort,” he says. “Facility managers should look for products that have been third-party tested and certified as low emitting, VOC-compliant, and that are easily cleanable and resistant to mold and mildew growth.”

Room acoustics are an element that may not be given much attention, but how a room sounds actually affects residents’ health and quality of life — a key consideration in room design, Hamilton says.

“It’s no leap of faith to say, if given the choice, residents at senior living facilities would prefer a quiet environment rather than a noisy space,” he says. 

“It has to be the right kind of sleep, and we’re not sure how to induce this kind of slumber in the human brain yet,” said senior author Paul Shaw, Ph.D., associate professor of neurobiology. “But our research suggests that if we can learn how, it could have significant therapeutic potential.”

Scientists intentionally disabled a gene responsible for memory in three groups of flies. The first developed a condition similar to Alzheimer’s. Another had a hard time reinforcing new connections to encode memories. In the third, the disrupted gene left the flies with too many connections.

The study, published online in Current Biology, showed the flies could cope with any of the conditions with increased sleep.

The research team used three techniques to increase sleep: stimulating a cluster of key brain cells, boosting production of a sleep-related protein, or giving the flies a drug that mimicked a chemical messenger.

Three to four extra hours of sleep per day for as few as two days restored the flies’ ability to make memories. The gene was still disabled, but Shaw said the additional sleep helped the brain create a “work around.” 

“In all of these flies, the lost or disabled gene still does not work properly,” noted lead author Stephane Dissel, PhD, a senior scientist in Shaw’s lab. 

“Sleep can’t bring that missing gene back, but it finds ways to work around the physiological problem,” Dissel added.

Shaw and others believe sleep helps the brain reinforce connections between brain cells that encode important memories and cut back connections that encode useless information.

Shaw works with fruit flies to explore the brain mechanisms that control sleep, which he and others have shown to be similar to those seen in people. 

Alzheimer’s disease is the most common cause of dementia.

Yet in spite of these generally recognized complexities and challenges, many sponsors and owner/operators still focus exclusively on tracking and evaluating their financial position on a broad consolidated basis. This is a great big-picture summary approach, but the true financial dynamics and sensitivity of the organization must address the development of individual cost and profit centers within the continuum. Simply combining three or four businesses within a community into one simple consolidated income statement of revenues and expenses is not the best practice for the future. In reality, each of these major product and service businesses should meet reasonable industry financial benchmarks of:

1. Revenue

2. Expenses

3. Net operating income

4. Profit margins

5. Cash flow

Each cost center must initially stand alone before being merged into the consolidated financial statement. Just using consolidated financials can frequently mask unacceptable subpar performance of one cost center, while penalizing another one.

Clearly owner/operators must provide a seamless consolidated continuum of products and services for their aging residents. But this consolidated continuum is really composed of a number of individual business models with unique challenges and opportunities. Each key element of this continuum must first be segmented as standalone cost and profit centers and then (and only then) combined to track the results on a consolidated basis. Each business element must be successful individually. 

Let’s take a look at a typical example. One of my clients operates a comprehensive CCRC that has independent living, assisted living/dementia/memory care, nursing/rehabilitation and assistance-in-living/wellness as major components in their seamless continuum for their residents. These components have each been segmented as these standalone profit centers. Individual income statements exist for each one. These individual income statements include earned operating revenues, operating expenses including direct costs and an appropriate overhead allocation that applies to that cost center, individual net operating income, profit margin and cash flow. These financial statements also include monthly and year-to-date budget versus actual results and, where appropriate, a discussion of why variances occur. 

This approach also quantifies and enhances the objective assessment of key staff member performance. Coupled with resident satisfaction scores, this provides an objective criteria for addressing important initiatives.

The senior living continuum is becoming more complex, with services like comprehensive assistance-in-living within independent living, geriatric assessment, memory care and external continuing care at home. Financial performance sensitivity is also increasingly putting more pressure on profits, debt service coverage and capital investment needs impacting overall cash flow for aging physical plants.

The standalone cost and profit center is a concept whose time has arrived. It is already being implemented by progressive sponsors and owner/operators. The benefits include sharpened pricing, focused cost controls and potential overhead cost reduction. Finally, the concept is fast becoming a key element of a state-of-the-art business practice. 

Jim Moore is president of Moore Diversified Services Inc., a national senior housing and healthcare consulting firm based in Fort Worth, TX. 

Because millions of doses are needed each season, the vaccination formula is determined months in advance to allot time to make the doses, the U.S. Centers for Disease Control and Prevention said in its most recent report. Components of the vaccine have been adjusted to accommodate more circulating viruses for the 2015-2016 season, the agency stated. 

“Influenza activity is unpredictable in terms of what virus will predominate and the exact timing of the season, and both of these things, along with others, can have a large impact on season severity,” explained CDC Epidemiologist Lynnette Brammer.

One version of the vaccine, quadrivalent flu vaccine, will protect against two influenza A viruses and two influenza B viruses. The new shots will contain two type A viruses, H1N1 and H3N2, and a type B component. These strains are expected to be the main ones of next season, Brammer noted. 

Last year, only 18.6% of shots were effective against H3N2 because nobody expected that strain to predominate and was not worked on until February, Brammer added. 

DEMENTIA HELP

Dementia-related behavioral disturbances are one of the top reasons senior living residents are readmitted to hospitals, according to experts affiliated with the Centers for Medicare & Medicaid Services.

Specialized training could help staff better handle disturbances and decrease the need for antipsychotics, according to those speaking on an MLN Connects conference call involving the National Partnership to Improve Dementia Care and Quality Assurance & Performance Improvement. Researchers Monica Tegeler, M.D., and Kathleen Unroe, M.D., MHA, of Indiana University included results of a study on the effect of training on staff comfort in dealing with dementia-related behavioral disturbances.

SALMONELLA BLAMED

A salmonella outbreak at Heritage Corner Assisted Living facility in Ohio may be the reason for the death of two residents, according to local reports. Health officials have not released an official cause of death at press time. 

There were 18 positive cases of salmonella starting at the end of May, officials said. The outbreak appeared to have ended by June 10. The investigation is ongoing.

The county health district advised the facility to close common areas for sanitization and serve meals in takeout containers. The areas were reopened after no new symptoms were reported for 72 hours. 

STIMULATING DISCOVERY

Communities with strong environmental stimulation are more likely to decrease the apathy levels among their residents with dementia, researchers have found. 

About 90% of residents with dementia experience apathy and are not motivated to engage in everyday activities or socialize with other residents, Ying-Ling Jao, RN, Ph.D., assistant professor of nursing at Penn State, said. Engagement is crucial, however, because dementia has been shown to decline quicker in those who are apathetic. 

In Jao’s study, published in The Gerontologist, 40 residents with dementia were observed via video while having a meal, directly interacting with staff members, or doing random activities. Jao watched and focused on the environmental characteristics around the residents, including stimulation, ambiance, crowding, staff familiarity and lights and sounds. 

VERSATILE DIABETES MED 

Prior research has shown older adults with diabetes have a higher risk of developing dementia, but a new study finds that a frequently prescribed diabetes drug could reduce that risk.

Researchers from the German Center for Neurodegenerative Diseases found that diabetics were less likely to develop dementia if they were treated with pioglitazone. The medication is used in short-term and long-term treatment of diabetics whose bodies are still able to produce insulin. Researchers found a correlation between dosage duration and dementia risk. Results were most favorable among patients taking the drug for two or more years. 

The study analyzed data from 145,000 men and women age 60 and older, and found that after taking pioglitazone the risk of developing dementia was around 47% lower than in non-diabetics. Metformin, another popular diabetes medication, was also found to lower the risk of dementia, but not as significantly as pioglitazone.

PARTY ENDS FOR RESIDENT

A Pennsylvania assisted living facility apparently was willing to look the other way whenever one of its residents would return from a “booze run” to pander liquor to other residents, but not when its staff discovered a prostitute under the man’s bed, according to published reports.

The unidentified facility in Montgomery County said it recently informed the resident he would be kicked out, and resultingly lose his housing subsidy — part of the $1 million in subsidies county commissioners authorized last year to just 21 assisted living seniors — after learning he was using the liquor run profits to pay for prostitutes.

County Chief Financial Officer Uri Z. Monson described the man as a “more mobile gentleman” in his 70s who would charge residents for liquor delivery.

THEFT LEADS TO PRISON

An assisted living aide said the looming threat of becoming homeless was what prompted her to steal a resident’s wallet and checkbook before eventually being arrested for forging $10,000 in checks. 

Elders who used tablets felt more confident with technology overall, according to a study conducted by Shelia Cotten Ph.D., professor of media and information at Michigan State University.

Not only are tablets small, lightweight and portable, they are easy-to-use at any age. The simple touch screen helps elderly hands maneuver quickly without having to struggle to use a mouse, Cotten explained.  Also, the bigger screens make it easier for them to use than cell phones. Even with little computer experience, seniors caught on quickly, especially with the help of family members, she added.

Aside from reducing tech-anxiety, using tablets is beneficial to seniors’ health. With the Internet at their fingertips, they can access health information, medical records and more. It has also shown to help ward off depression by making it easier to connect with loved ones.

The sample group consisted of older adults in an assisted living community who had tablets, and had participated in a larger technology study, Cotten said. From there, they found other contacts and scheduled in-depth interviews to find out what factors were important, what they learned from tablets and the benefits versus the challenges. 

“One thing that was interesting is that the older adults were a little territorial; they didn’t like to share their tablets,” Cotten said. “But the sense of connection … they felt more connected to the world and not lonely.” 

“The use of tablets is going to increase across older adults in general, and in communities because they are just so much easier to use.”

CONTRACTORS SLOW

Information security at nine selected Medicare administrative contractors, at least as of two years ago, was improving, but deficiencies remain, according to a report released by the Department of Health & Human Services Office of the Inspector General. 

The April 2015 report’s release comes at a time of heightened awareness in government after a series of highly publicized cyberattacks on the Department of Defense and the White House.

In its analysis for fiscal 2013, PricewaterhouseCoopers (PwC) found there were 19% fewer “gaps” in security requirements than the year before. PwC uncovered a total of 119 gaps, which are defined as the difference between the core security requirements and the contractors’ implementation of them. These 119 gaps were consolidated into 67 findings. Contractors are evaluated based on standards established by the Centers for Medicare & Medicaid Services and the Federal Information Security Management Act of 2002 (FISMA).

The majority of identified gaps were in the areas of policies and procedures to reduce risk and periodic testing of information security controls.

PwC identified 42 policy/procedural gaps in areas that included system configuration, patches and malicious software protection. A total of 39 testing gaps were identified, including areas such as system inventories and security configuration issues and weaknesses. In a third major evaluation area — incident detection, reporting, and response — PwC uncovered gaps in log review policies, reporting of scans and probes and undocumented intrusion detection and monitoring procedures.

Perhaps most disappointing were the number of reoccurring findings from fiscal 2012. PwC identified nearly 30% of the 2013 issues as “repeat” findings. More than half of the repeat findings were identified as “high risk.”

Information security requirements for Medicare administrative contractors, fiscal intermediaries and carriers, all of which process and pay Medicare fee-for-service claims, were established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Each Medicare contractor must have its information security program evaluated annually by an independent entity, and is responsible for developing a corrective action plan for each finding, according to the OIG report.

NEW USE FOR ROBOT

Japanese researchers have created “Terapio,” a robot that replaces medical carts commonly used in a hospital. The autonomous mobile robot can track a specified human while avoiding obstacles. 

Terapio also can record personal and vital signs, and display a patient’s health records. Researchers said this allows the human caregiver to have more personal interactions.

BREACHES COSTLY

The average cost for a data breach is now $3.8 million, according to a report from data security research organization Ponemon Institute. The direct costs related to hiring experts to fix the breach, investigating the cause, setting up hotlines and offering credit monitoring. 

CHIP SHOWS PROMISE

A new chip can test for antibiotic resistance in an hour, which could help physicians pick the most effective antibiotic to treat infections. University of Toronto researchers created a glass chip that flows the sample that contains bacteria through microfluidic wells. They published their work in the journal Lab on a Chip. Their future work will include being able to test different antibiotics at many different concentrations.