The 50-foot wall was from a redesign in the 1960s. It held up one end of a canopy, forming a drive-through entryway. 

“It probably looked cool in the ’60s,” Phillips says. No more.

It blocked light from entering; there was no view out the front of the facility; residents couldn’t even gauge the weather by looking through the windows. Every landscape designer that came through would ask about removing it. 

In 2013, administrator Libby Goodman decided it was finally time to tear down that wall.

Demolition planning 

Goodman sought input from members of the staff and from residents about how to make the new entryway something special. Then she started contacting area designers.

“We kind of knew what we wanted, but we didn’t tell [the designers] at first; we wanted them to be creative and come up with their own ideas,” she says. 

When the project began in July 2013, the impact was immediate. 

“The day that the contractors were tearing the wall down, we had a backup of employees and residents out in the hallways,” Phillips says. “There were a lot of ‘oohs’ and ‘aahs.’”

Creating space

With many demolition projects, there’s a worry that the facility will be taking away an area that residents enjoy. In this case, a brand new area was created. 

The new entryway is bright and open, with good views from the lobby and nearby dining room. 

Outside the main entrance is a large area for sitting and gathering with friends and family. Half a dozen “nooks” provide a feeling of privacy, despite being outdoors and surrounded by other residents. 

“That was something we really thought about,” says Goodman. “We wanted people to feel like they’re outside, but not part of everyone’s conversation.”

Life and joy

The project culminated on October 3, 2013, with the dedication of a new statue, a Tree of Life, in honor of the Sisters of St. Francis, who ran the facility for nearly a century. 

Designed by Missouri artist Donald Horstman, the sculpture is filled with religious symbolism, including three-part leaves representing the Holy Trinity, 12 doves flying toward heaven representing the 12 tribes of Israel and the 12 apostles, and a lamb resting at the base of the tree representing gentleness, meekness, purity and the unblemished Lamb of God. 

In the end, Goodman says, the real impact on residents is something simple but profound. 

“They’re just so happy to be able to see out the front door,” she says. “I know when you say it that way it doesn’t sound like a big deal, but it is a big deal. They say, ‘Oh, look at that sunshine,’ or, ‘Look at that snow,’ and it’s joyful.”

That adage seems especially relevant for handling the wishes of residents dealing with terminal conditions. Or for that matter, handling the wishes of others who feel their mortal coil has become unbearable.

When it comes to choosing the best course of action, some will argue it is ultimately the individual’s right to decide. Others will insist that the sanctity of life is too precious to be cut short by mere human intent.

Clearly, wise guidance and insight would be helpful. But what the world has been doling out lately has been anything but.

Consider what’s happening in Switzerland. Lawmakers in the canton of Neuchâtel recently passed a law specifically allowing organizations that provide assisted suicide to advertise in government-funded eldercare communities. If managers object, well that’s just too bad. In fact, the new regulations prohibit staff from interfering.

Closer to home, Oregon, Vermont and Washington now allow assisted suicide, and the issue is being debated in New Jersey. Things are also percolating in Montana and New Mexico, where courts have ruled on the side of providers assisting in deaths.

The assisted-suicide debate regained national attention recently, when 29-year-old Brittany Maynard — who was terminally ill with brain cancer — opted for an early death over prolonged suffering.

In the interest of full disclosure, I must admit that I have decidedly mixed feelings about assisted suicide (or as some prefer to call it, aid in dying). I can’t think of anything that is better than being alive. To me, it’s the best game in town. But I might feel a bit differently if a physician told me that the latest test results confirm the worst.

So what’s the right thing for senior living operators to do here? The talking heads who have staked their claims on this debate say it’s simple: Just do it their way. Unfortunately, that’s hardly the kind of helpful guidance most others seek.

And things may soon get even more tangled. As never before, hospice care is becoming a long-term staple. At the same time, the marvels of modern medicine are keeping older people alive longer than ever. So much so that by the time they get to skilled care settings, their bodies tend to be racked by illness and disease. So who lives? Who dies? And who decides?

I can’t pretend to have the answers. But I can offer some advice: Put compassion first. As for what’s best after that? At some point we all need to find answers we can live with.

Because senior housing — assisted living in particular — is a hybrid of hospitality and healthcare, the sector hasn’t been included in the government’s electronic health record and Meaningful Use interoperability initiatives that hospitals and medical centers have been working to achieve. What’s more, the entire long-term care sector has been excluded from eligibility for the American Recovery and Reinvestment Act of 2009, which earmarked billions for deployment of interoperable systems.

Even so, senior housing operators should be assessing how information technology can make their operations more efficient, cost-effective and quality-oriented, automation specialists say.

“They are late to the party, but they can catch up,” says Jon Shankman, senior vice president of clinical innovation for AMC Health. “What we’ve learned is that assisted living needs to be defined. They need to find out where they sit — are they residential, are they care-oriented and how do they handle chronic disease management? How are they defining the clinical services they provide?”

Other questions assisted living operators need to ask, Shankman says, are what technology can do to help residents and how it can bring a window into caring for people with chronic conditions, which he refers to as “continuous patient knowledge.”

As a supplier of various health monitoring solutions, AMC is targeting the assisted living industry as a new horizon for its products, Shankman says. The solutions monitor a host of chronic conditions, including diabetes, chronic heart failure, COPD, asthma and medication adherence. It also offers biometric monitoring, interactive response, video visits, personal emergency response services and clinical telecare management services designed to interact with the care team.

“Because our clients bear the largest cost of utilization, the information has to relate to specific chronic diseases so that caregivers know what needs to be done,” Shankman says.

An evolving sector

Healthcare IT is still evolving in the senior housing sector, falling into two basic categories: property management-oriented systems and electronic health records systems created for use in skilled nursing organizations, says Kim Ross, senior director of marketing for MatrixCare.

“Rising acuity levels in senior housing communities are creating a need for more clinical functionality, which is a challenge for property management-focused systems,” she says. “By contrast, EHR systems developed for use in skilled nursing facilities include functionality that is based on clinical and operational workflows that are not workable in a senior housing environment.”

In essence, Ross says senior housing doesn’t have an IT system that has been developed to fit is operations.

“At a recent conference one senior housing executive said ‘I’m looking for a unicorn and haven’t found it yet,’” she says. “‘The unicorn’ being a system that was developed with the needs, processes and workflows of senior housing communities in mind.”

David Wessinger co-founder and chief technology officer of PointClickCare, maintains that even though EHRs are linked to the ARRA interoperability initiative and despite senior housing’s exclusion from federal funding, operators should nevertheless actively pursue adopting the systems for their facilities.

“It is recognized that EHRs will lead to better outcomes and reduced healthcare costs,” he says. “For senior care providers, implementing an EHR platform supports the Meaningful Use goals of the hospitals and physicians they work with, resulting in higher value relationships with these key partners.”

Electronic Medication Administration Records — or eMARs — can also bring “great value” to assisted living facilities, says Gina Timmons, vice president of customer facing technology for Omnicare.

“Senior housing typically offers its residents a medication management option to assist with medication adherence and basic monitoring,” she says. “The eMAR medication orders are electronically populated by the pharmacy and include many additional educational warnings, precautions and monitoring cues for the caregivers.”

The eMAR allows data to be monitored from various points of view to ensure that residents are taking their medications as directed by their prescribers, and watches for any trends across the community, Timmons says. 

Omnicare is also pursuing integration opportunities with biometric devices that monitor the effectiveness and potential side effects of medications.

“The entire senior care team is interested in the trend data available in from these devices, like weight, blood pressure, glucose levels, oxygen and other readings,” Timmons says. “The residents can use these devices independently and still have their readings charted within their electronic health record.”

‘Silo’ environment

The senior housing IT environment has a steep climb to interoperability and full automation due to the “siloed” nature of their systems, says Mark Woodka, chief executive officer of OnShift.

“Many senior housing facilities are lacking robust EHR capabilities,” he says. “They are lacking systematic care tracking and service tracking capabilities.”

A major challenge for senior housing providers is revenue leakage, Woodka says, stemming from the inability to capture the necessary billing details so that revenue can accurately reflect the services they deliver.

“In addition, their greatest operational expense is labor, which typically represents about 50% of their costs,” he says. “Many senior housing providers are still scheduling and managing staff manually with pen and paper — it’s shocking. Labor management is a key area that they should be addressing systematically with core technology to help them manage their number-one expense.”

To achieve greater IT functionality, senior housing providers need to install enterprise-wide systems, Woodka says.

“They need to work with software vendors that offer integrated solutions but also work with other software vendors so they can truly get end-to-end technologies,” he says. “There is no one vendor offering every end-to-end component that they need. One solution is best-of-breed, relying on vendors that integrate well together.”

Tackling dysfunction

Although IT systems have become quite advanced and sophisticated, senior housing facilities don’t need to invest in highly complex functionality, says Doc DeVore, director of clinical informatics and industry relations at AOD Software.

“Information technology for assisted living is basic and typically does not require a robust solution other than the ability to track services and bill appropriately,” he says. “Although we are seeing a trend towards higher levels of care being provided, assisted living still remains a retail live-at-home operation. Thus the need for a full clinical software is not usually necessary.”

The typical technology requirements for assisted living centers around marketing their services, tracking the services provided, and collecting the appropriate revenue for those services, DeVore says.  

“Currently they are usually lacking a single software system that will track and bill appropriately, which creates efficiency as opposed to having to do multiple data entries in multiple software systems,” he says.

Having one IT specialist on staff, let alone a team, has been elusive for senior housing facilities and skilled nursing facilities alike, says Duke Yetter, founder and CEO of Mobile Medsoft.

“Not everybody has a qualified IT person nor do they understand how important it is to their organization,” he says. 

Consider the cloud

One of the fastest growing segments of healthcare IT has been remote data hosting in cloud-based servers. The concept has caught on in the industry because it is a low-cost, low-maintenance alternative to in-house servers and infrastructure. It is an adoption that senior housing facilities can easily make, IT specialists say, because it typically can be configured relatively simply.

One of the many advantages of the cloud is that it is a “‘grow as you need to’ model as opposed to a full purchase option,” says Jeremy Spradlin, CEO of CareServ Technologies. “The cloud hosting model allows smaller organizations to get the technological expertise that the hosting company provides.”

Another option for operators to consider is HaaS (Hardware as a Service), a model that involves leasing the equipment for a period of time and then turning it back in for a brand new system without increasing expenses.

“From copying machine to handheld devices, this outsourced IT function is particularly valuable to organizations just starting out with enterprise EHRs and mobile documentation strategies,” Spradlin says. “It is cost-effective and reliable.”

Fulfilling this need isn’t easy, however. Increasing comorbidities and care needs that often rival those seen in skilled nursing facilities — coupled with limited resources and sometimes inadequate staff training — can set facilities and their residents up for frustration and failure. Sometimes, assisted living operators recognize the importance for highly individualized care plans and resident enrichment programs, but they lack the knowledge, resources and tools to make it happen. The result is often a one-size-fits-all approach that, at best, fails to reach residents in uniquely satisfying ways and, at worst, leaves residents and staff feeling agitated and disconnected, sources told McKnight’s Assisted Living.  

“We have an obligation to be committed to addressing the needs of individuals with dementia,” says Loretta Bartz, ORT/L, VP of clinical training and program development for Heritage Healthcare/HealthPRO Rehabilitation. “It’s essential that we acknowledge that traditional approaches to addressing [resident] needs are not going to be successful.”

Play detective

Enriching resident experiences and delivering fulfilling programs and services takes facility-wide commitment and involvement, and recognition that residents can stay positively engaged, regardless of where they fall on the dementia scale.

“We tend to think people with dementia are separate species when, in reality, they have the same needs we all do. They want to be connected to others, to feel loved and valued, and — to the best of their ability — contribute something to others,” says Kathy Laurenhue, CEO, Wiser Now Inc. “If we start with that universal premise, we can create a warm and comforting atmosphere that [serves as] the basis for everything else.”

Staff must be well-educated in dementia care, and this goes for all members of the care team, from admissions and nursing to therapy, activities, dietary, and more. Often, providers ask staff to do their best, but don’t give them the right tools to make that happen. Activity staff, especially, may lack cognitive impairment training and not understand disease management basics, which can hamper their ability to delivery resident-centric programming and care, according to Ryan Ries, president of TranslaCare. 

“This can progress to the point where the elder becomes increasingly disconnected and has more care challenges, and can no longer remain in assisted living.” Another common misstep is hiring activity consultants to ensure compliance with survey requirements, without recognizing that compliance doesn’t automatically mean all needs are being met, Ries says. 

Further, some facilities design aesthetically-pleasing spaces, but don’t give enough thought on how to use them effectively. “What I see too often is a gorgeous-looking space where nothing is really happening. Engagement is a wonderful concept, but it requires a team effort — where everyone is involved in program planning and participation,” explains Laurenhue. “That means asking residents, families and staff for their input and their talents.”

Assessments upon admission and then on an ongoing basis are key to meeting residents’ unique and ever-evolving needs. Upon admission, staff should inquire about personal preferences, past occupations and interests, and meaningful life roles. 

“ALF staff must include families in order to get a comprehensive understanding of the individual’s life prior to the onset of dementia,” says Bartz. “By understanding the unique way a resident engaged in even the simplest activities, such as the way one initiated involvement in brushing their teeth, will help staff replicate the context in which this resident completes the task. They will also be able to provide the cues needed to continue carrying out [the task], rather than ‘taking over’ and just doing the task for the resident.”

Activity assessments, too, must delve deeper than just leisure skills and interests, adds Ries. “When I retire to assisted living and an activities person interviews me, I won’t have hobbies to report. I will have important life roles to talk about. Too many activities focus on leisure skill areas, and not enough are geared toward life roles.”

Facilities may struggle with adapting personal preferences and past roles into meaningful programming. Staff may know a resident’s interests, but it takes ongoing investigation to apply that information to programs that facilitate engagement and socialization, and deliver therapeutic outcomes.

“We must become comfortable in our role of detective and in uncovering the strengths to ensure the highest quality of life,” says Bartz.

Direct caregivers need strategies, standards and tools to collect and analyze life stories, plan around existing abilities, easily access and update ongoing preferences, engage and educate family members, train support staff, and provide them with consistent guidelines, pointed out Gina Cambre, national director of CL University/senior director of Operations for Connect Living.

What’s more, staff must understand that memory care, engagement and quality of life are not merely a philosophy, but an organization-wide practice. 

“We need to use a practical approach to providing person-centered care, consistently, every day for every resident, and allowing them to maximize their abilities daily, at every stage of their journey,” says Hollie Kemp, PTCCL, CDP, CADDCT, corporate director of dementia services for Compass Pointe Healthcare System. 

Stay in the moment

Recognizing dementia stages and being creative in modifying approaches to allow residents — even those with severe dementia — to stay engaged is essential. This helps slow cognitive decline, which helps maintain a higher level of independence and quality of life for each resident, assures Dana Tingley, MS, CCC-SLP, regional VP of operations, Heritage Healthcare/HealthPRO Rehabilitation. 

“Many times, we focus on the disability and what a resident cannot do, rather than recognizing their continued strengths and skills,” she says, adding that another common mistake is labeling many observed behaviors as problematic or negative. Often, these behaviors are a resident’s attempt to communicate to staff their confusion, lack of recall, frustration, or even pain, she explains.

Therapists can recognize the root cause of “behavioral” issues and collaborate on identification of effective strategies and how best to implement them to maximize independence and participation, notes Bartz. 

Early-stage dementia residents may begin withdrawing from previously enjoyed activities because of the emotional impact of their symptoms, and their inability to be engaged with a typical system of behavioral prompts. They may no longer recall days and times of activities featured on monthly calendars, or may not know the day or time. Transitional programs allow providers to begin a series of interventions that prevent isolation, according to Cambre. For early-stage dementia residents, this may include prompting for daily calendars, calling residents prior to activities, or initiating “pick me up” groups where residents knock on one another’s doors and travel together to activities.  

Those with mid-level dementia often live in the past. Familiar activities, such as watching television show from the 1950s or 1960s, can be done for 20 to 40 minutes at a time, whereas new learning activities like handicrafts that involve direction-following can be done for one to two minutes at a time, says Ries. Late-stage dementia residents require multi-sensory activities involving at least three senses for maximum engagement, he adds. “This also requires interdisciplinary integration of therapy and daily living activities to ensure all cognitive levels are included.”

Tap technology

Today, there’s a breadth of technologies to further enhance resident engagement, familial connections and quality of life. These solutions can evolve with residents and provide meaningful interaction — in a group or one-on-one — no matter the degree of cognitive impairment. 

Computer- and web-based technology is gaining momentum, some offering extensive content libraries that can hold each resident’s unique preferences, profiles and targeted engagement programs, and let staff gear activities accordingly. If a resident was once an avid hunter, for example, he could perhaps be given a Nerf gun, so he can watch on a large television screen a video of a deer crossing in the woods, and be instantly “transported” to the north woods, says Lori Snow, regional sales and marketing director for It’s Never 2 Late. A resident who enjoyed ballroom dancing can watch various dances with the click of mouse on a custom home page, she adds.

Increasingly, solutions are tapping the benefits of existing technologies and allowing residents to stay better connected with loved ones. “We’re driven by social impact, and committed to the idea that a connected life transforms the experience of aging,” Cambre notes.  Connected Living’s private resident and family portal provides a secure, easily accessible mobile database of individualized care plans and evolving preferences. “We partner with industry thought leaders to bring guided, therapeutic, multi-sensory life enrichment content for the highest level of engagement.” This includes music therapy and games via Ph.D. music therapists, guided reminiscing and more.

Solutions like Skype are also providing meaningful, therapeutic interactions, Snow says, and even televisions themselves are being designed with resident-friendly features that offer far more than just entertainment. SeniorTV’s
PlaybackNOW automated DVD system lets staff schedule and play movies and create soothing videos.  

“Another built-in feature on our own brand of LED TVs allows a USB card to be plugged into the TV, so pictures and music media can be played by pushing a button on the remote,” says Savy Sabino, sales manager, Stella Private Cable Systems – SeniorTV. “The USB card can be loaded with family pictures and memories by a family member.”

David Anderson, national sales manager at Apollo Bath, says the state of bathing in senior housing has been undergoing an evolution for about the past 20 years and continues to improve.

“Visit any facility today and you will likely see ‘Spa Room’ on the door entering the bathing area,” he says. “This is because while the primary purpose of bathing systems is for hygiene, today’s facilities want to provide a more relaxing and enjoyable spa experience.”

The bathing process has historically been an area that poses a variety of challenges for assisted living facilities. The chief concern, naturally, is safety. But providing comfort, relaxation and aesthetics is also essential to a first-rate experience, says Rachelle L. Congdon, vice president of marketing for MasterCare.

“More facilities ‘get it’ with regard to bathing,” she says. “This is an exciting trend toward developing communities that serve to transform lives by providing luxury and resort-style amenities and atmosphere. It is really gratifying to know that we are finally transforming bathing by putting more emphasis on physical, emotional and spiritual well-being of seniors and physically frail individuals.”

Fran Spidare, product development manager for safe patient handling at Invacare, also sees tremendous improvements in bathing operations.

“Many now understand the importance of creating a relaxing bathing environment,” she says. “They balance the time required for true hygiene with the time for relaxing in the physical and emotional warmth of the total environment.  We are seeing more centers with beautifully designed bathing areas.”

Creating ambience

Adding aesthetic elements to the bathing experience are the touches that offer a truly inviting environment. But it starts with creating an area that is designed to accommodate bathing, Spidare says.

“The bathing tub is especially important as it provides easy access for clients of every physical condition, with hydro jets that actually move the water,” she says.  “This movement of warm water relaxes the muscles. These jets should not constrain the use of bath oil, bath salts, or the client’s favorite soaps and shampoos. What good is a relaxing bath without your favorite soap?”

Color also is an important part of the spa design scheme and more facilities have become creative in deploying it, says Lee Penner, president of Penner Patient Care.

“If the facility has an interior decorator, we can work with them,” he says. “If they have chosen the décor, we can create something that will match. We will provide custom colors and granite-like textures. By using color, you can create a spa that blends well with the room so it looks built in, not sterile and institutional.”

Some Penner units have a TV built into the cabinetry so that residents can watch their favorite DVDs while bathing.

Congdon condones using ambience-inducing elements, such as aromas, lighting and music.

 “Aromatherapy — a standard feature on MasterCare tubs — is a nice way to offer that soothing scented, relaxing environment without lighting a candle, which is restricted in many communities,” she says.

Another key to pleasant bathing is planning ahead, Congdon says. 

“Know about the residents you’re bathing and their preferences,” she says. “Having all toiletries, soaps and lotions each resident likes readily available is essential, as are a soft wash cloth, warm towel, fresh set of clothes or robe.”

Safety concerns

Without sound safety procedures, none of the cosmetic bathing attributes matter, specialists say. One of the preeminent safety measures should be preventing slippery surfaces, Spidare says.

“Keeping the floor as dry as possible is key to a safe environment for caregivers and clients alike,” she says. “This goes back to the design of the room — the floor should be slightly sloped to allow for good drainage. Rubber mats should be used to provide traction and slip resistance.”

Bath entry and exit can be hazardous and the process should be handled with extreme care, Congdon says. Making certain the bathing room is warm is another good idea, because being cold can lead to hurrying, which leads to slips.

“Getting out of the tub is especially important because the resident is wet and needs to be as dry as possible,” she says. “Standing on a dry towel or clean bath mat will help prevent slipping. Also, providing a tub with a chair or transfer device so there is no stepping is also helpful.”

Infection control is another vital safety procedure due to the risk of cross-contamination and nosocomial pathogens, Anderson says.

The privacy factor

Creating an air of dignity and privacy is another critical facet of a first-rate bathing operation. While the ideal environment is to have a bathing area with a single whirlpool system, a toilet and sink for one occupant, Anderson concedes it’s not always possible.

“While the trend now is to call the bathing area the ‘spa room,’ these are still centralized bathing systems and the resident population needs to be considered,” he says. “A qualified staff member should always be present to assist with the bath process and deal with any potential issues that may arise.” 

Specifically, excessive treatment of warfarin (to prevent blood clotting) and antiplatelet therapy with aspirin or clopidigrel (to prevent stroke) can be harmful, noted presenters at the a recent meeting of the American Heart Association in Orlando, FL.

Atrial fibrillation is a common heart rhythm abnormality that raises the risk of stroke and all common forms of dementia. The mechanisms behind the association of atrial fibrillation and dementia remain unknown.

“The dual drug regimen is often used to prevent strokes in people with coronary artery disease or peripheral vascular disease, but we have to consider that long-term exposure to anti-clotting drugs such as warfarin, if not well controlled, can significantly increase bleeding risk,” said T. Jared Bunch, M.D., lead author of the study and director of electrophysiology at the Intermountain Heart Institute in Murray, UT. “This may result in micro bleeds in the brain that don’t cause symptoms right away, but accumulate over time, raising the risk of dementia.”

Researchers studied 1,031 patients with no previous history of stroke or dementia for up to 10 years while on the drug combination. Patients who had abnormally slow blood clotting times — International Normalized Ratio measurement above 3 — on 25% or more of their monitoring tests were more than twice as likely to be diagnosed with dementia than patients whose tests showed overtreatment less than 10% of the time. The increase is higher than what researchers found in a previous study of warfarin alone.

Patients who had abnormally slow clotting times were considered to be receiving too much
medication.

“Even at skilled centers, it’s very common to have INR outside the ideal range up to 40 percent of the time, and over the years there may be an accumulative negative impact on cognitive ability,” Bunch said.

The minimum wage issue poses both an ethical dilemma and a real world business challenge. Two conflicting issues are emerging: 1) a legitimate moral and financial concern for lower paid, entry level employees versus a potentially serious fundamental business impact.

Many feel that modestly increasing the standard of living for lowly paid workers is the right thing to do. But price- and profit-sensitive businesses with high concentrations of low-cost workers are concerned. Industries like fast food would be dealing with several critical variables such as higher prices, possibly a lower customer base, or lower profits. Consideration is also being given to lowering cost by reducing entry level employee counts. Simply stated, the fast-food industry and other businesses may have to re-evaluate and adjust their business model.

There are also concerns that if the baseline minimum wage of $7.25 per hour (the current federal standard), is increased to at least $8.75 per hour, there could also be pressure to increase the hourly wages of other lower paid entry-level employees in an attempt to sustain the current offset from the increased minimum wage. New York, California, Oregon, Connecticut and Massachusetts have already set their minimum wage higher than $8.75 per hour. Other states already either have an official minimum wage of at least $8.00 per hour or are considering similar increases.

So how and why might this affect the senior living industry? There is a heavy concentration of entry level workers at a typical independent living or assisted living community. Those entry level positions typically include housekeepers, laundry personnel, cooks, servers, and other dietary employees, as well as drivers, security personnel, some maintenance positions, and healthcare workers.

Real world example

Let’s look at a typical real world assisted living community called The Gardens at Westridge with 110 units and 55 full-time equivalent employees (FTEs). This staffing ratio of 0.5 FTEs per unit is a typical benchmark. In The Gardens, the types of lower wage earner workers mentioned earlier totals 43 FTEs. Their current entry level wages range from $11.00 per hour (housekeeper, laundry and some health care support, security and maintenance workers) to $11.70 per hour for CNAs.

There could eventually be pressure by workers, labor unions and other interest groups to attempt to sustain the current offset between minimum wage levels and other entry level worker pay. For example, if the minimum wage is increased by approximately $1.50 per hour, this offset, if also achieved by other workers, would have a significant financial impact on this assisted living community.

A financial sensitivity analysis of this issue conducted for The Gardens at Westridge revealed the following:

• Annual payroll increase of $149,800 or 10.2%

• Total expense increase of 4.5%

• Net operating profit margin decrease of 3.4% (from $1.5 million to $882,450 in net income)

At an 8.0% capitalization rate, the intrinsic value of The Gardens would decrease by approximately $1.9 million. Granted, the potential minimum wage increase impact on other entry level wages involves speculation at this time, but the change is very likely to occur.

There is a viable win-win solution to this potential financial dilemma. It involves three basic initiatives: 1) reducing overall operating expenses, 2) enhancing revenues and 3) realizing organic growth through increased occupancy and expanded services within the community. It is a very significant win-win solution because it addresses both the potential minimum wage financial impact and also improves the community’s long-run financial performance.

While these three approaches have been addressed in earlier columns, they are particularly relevant here. They provide a real option for any operator trying to be fair to employees while growing the business.

The Ages 2.0 project involved nearly 80 “vulnerable” participants, who were between 60 and 95 years old. They were all receiving services through Somerset Care Ltd. and resided either in the community or in one of Somerset’s communities. 

Compared to a control group, the study participants displayed improved cognition, a greater sense of self-competence and self-identity, and were more socially engaged, the investigators found. They were given a touchscreen computer and keyboard and three months of training in how to use social media such as Facebook and Skype. They kept the computer for a one-year period.

“We’re always keen to build upon and ensure continuity of our integration success and Ages 2.0 has provided the perfect research mechanism to help promote discussions around future models of care,” stated Mandy Seymour, chief executive officer at Torbay and Southern Devon Health and Care NHS Trust, a partner in the project. It was led by the University of Exeter, which announced the results.

Rotating shift dangers

Senior living nurses who work rotating night shifts might be at increased risk of death, particularly from heart disease and lung cancer, according to recently published findings from Harvard Medical School.

For nurses who worked rotating night shifts for at least six years, all-cause mortality increased 11%, the investigators determined. Cardiovascular disease mortality was about 20% higher for this group. For nurses who worked this type of schedule for 15 or more years, risk of death by lung cancer increased 25%.

Flu cases rising

The current flu season continues to be especially bad in the United States, according to the government’s latest flu surveillance report. Forty-three states have reported either high or widespread flu activity, the Centers for Disease Control and Prevention notes.

Senior living residents often have weakened immune systems, which can make them especially vulnerable, experts caution.

This year’s predominant flu strain, H3N2, has accounted for 95% of all cases reported. This strain is associated with more severe illness and more deaths. And the challenge will likely get worse, experts said.

SMART wound care

International researchers have teamed up to create a liquid bandage that maps oxygen concentrations in skin wounds.

A lack of oxygen can lead to chronic sores. Current methods to assess wounds are either subjective or require highly specialized staff or equipment, says Harvard Medical School Professor Conor Evans, Ph.D., the study’s lead author.

The bandage is made of phosphors — molecules that absorb light and then emit it via a process known as phosphorescence. It’s painted onto the skin’s surface as a liquid, and dries to a solid thin film within a minute.

New COPD guide

Residents with COPD should get pneumococcal and flu vaccines to manage their disease and ward off complications, according to new guidelines issued by two of North America’s largest thoracic societies.

Though the pneumococcal vaccine may not prevent acute exacerbations, first-of-their-kind recommendations from The American College of Chest Physicians and the Canadian Thoracic Society note that patients with the bacteria in their lower airway have a “significantly increased risk” of exacerbations.

Leg ulcer help

When senior living caregivers provide clear, tailored exercise and education to adults with venous leg ulcers, residents are more likely to engage in regular exercise — which can improve outcomes. 

The findings come from a series of interviews with 10 patients conducted by researchers at Queensland University of Technology in Brisbane, Australia.

Brain training, or computerized cognitive training, involves practicing mentally challenging exercises, and is popular in many senior living communities. 

University of Sydney researchers at the Regenerative Neuroscience Group at the Brain and Mind Research Institute did a meta-analysis involving 51 randomized clinical trials and around 5,000 participants. 

There were different factors related to whether training was effective. The analysis found group-based brain training with a professional trainer helps older adults with their cognitive skills, but self-directed brain training at home has no therapeutic effect. 

Another variable was related to training frequency, they said. 

“Training one to three times a week was effective, but training more than this neutralized any cognitive benefits,” said BMRI’s Amit Lampit, Ph.D., the study’s lead author, noting that brain training is similar to strenuous physical exercise in that patients need rest between sessions.

The researchers cautioned that while brain training can help cognition, it is not a “magic bullet.”

Modest gains should be expected, said Associate Professor Michael Valenzuela, Ph.D.

“We still don’t know if this type of activity can prevent or delay dementia. Much more research is needed,” he said.

Speech subtleties

Scientists at the University of Washington are working to teach computers to recognize not only the words we use but also the myriad meanings, subtleties and attitudes those words can convey. This type of “stance recognition” could help improve all kinds of speech recognition systems, says Valerie Freeman, a doctoral candidate in the department of linguistics at the University of Washington, who recently presented her team’s latest research on the Automatic Tagging and Recognition of Stance (ATAROS) project at an Acoustical Society of American meeting. 

“We’re trying to understand what is it about the way we talk that makes our attitude clear while speaking the words, but not necessarily when we type the same thing,” Freeman said.

In their study, the researchers recorded the voices of 68 people of different ages and backgrounds, all from the Pacific Northwest. When they reviewed the recordings, listening for cues that could reveal the speaker’s stance on a topic, they found that when pairs of people worked together on a task, they tended to speak faster, louder and with “more exaggerated pitches” when they had a strong opinion than when they had a weak one.  

IT plan is out

While physicians and hospitals are the main focus of an updated federal health information technology plan, senior living organizations were also identified as targets of a push into new territory.

The first two goals of the plan prioritize increasing the electronic collection and sharing of health information while protecting individual privacy, according to National Coordinator for Health Information Technology Karen DeSalvo, MD, MPH, MSC. 

The first goal “aims to expand health IT adoption and use efforts across the care continuum, emphasizing assistance for healthcare providers serving senior living, behavioral health, community-based, and other populations ineligible to participate in the Medicare and Medicaid EHR Incentives Programs,” report authors wrote.

Data missing

More analytics are needed for senior living technology, according to comments in a report by Majd Alwan, M.D., executive director of the Center for Aging Services Technologies. The report summarized a September applied research forum on technology and services for older adults, hosted by CAST and the International Association of Homes and Services for the Ageing. Presenters discussed how technology can help explain human behaviors, and turn data into usable information that can enhance quality of life for seniors.

Net shortage

Not many elderly Americans use the Internet to find appropriate health information, according to University of Michigan researchers. The study was published in the Journal of General Internal Medicine. Around 1,400 Americans 65 years and older answered questions about how often they used the Internet and when they searched for health information.

Eyes have it

A Pac-Man-style “cat and mouse” game helps improve vision in people with a lazy eye and poor depth perception, an Ohio State University study suggests. Researchers found weak-eye vision improved to 20/20 and 20/50 in research participants with lazy eyes whose vision was 20/25 and 20/63, respectively, before the training began. 

Seeing the future

University of Windsor researchers developed software that can generate predictions related to complex systems like epileptic seizures. After examining the electroencephalography readings of 21 patients with epilepsy, they found plugging just a half-hour of readings into their software gave data to provide a 17-minute warning before someone would have a seizure.