After clearing the site of three buildings, 30% of a fourth was used in the construction. New wings were connected to the facility, which uses some of the old exterior facade and meshes nicely with its neighbors in a residential area adjacent to commercial buildings and the nearby Vanderbilt University campus.

Signature worked through some issues that often pop up with construction of this type, which included navigating two sets of building codes (the City of Nashville uses the International Building Code and the health department uses the Standard Building Code). After getting clearance for a therapy pool through the Nashville building department and the state health department, Signature found it still needed to go through the city health department before it could be approved.

The configuration of the building, sitting on a 3.7-acre, L-shaped lot with a slope, also required a little finesse. But problems with the setback in one area and parking that’s slightly smaller than what the code calls for did not pose impassable hurdles, leaders pointed out.

“If the planning commission understands you’re giving them an honest building for the neighborhood — and given the use of the building, it’s something that serves the neighborhood well — I think they’re willing to work with you,” said Signature HealthCARE corporate architect Tony Waldron. 

As a tribute to the Nashville area, Waldron used the present and a part of his past to create a unique aspect of the facility — an amphitheater.

“I had a house for many years that had a nursing home behind it. They often had concerts for the residents and I was a (beneficiary) of that,” he said. “I always thought that was a neat thing. So that was something that I tried to give back to the neighborhood. A concert in the grass — that could be something that the neighbors could also enjoy.”

In fact, a summer music series featuring local artists was created.

The building’s cafe looks out into the amphitheater. The grassy area is sloped and large enough to accommodate the residents. 

Another specialty is the decor.

“All of the artwork was specifically selected as it relates to the wellness of our residents and their Nashville culture,” said Karen Veith, director of interior design. “There are many historical preservation sites and landmarks that the residents can easily identify, Cheekwood Botanical Garden and the Parthenon replica in Centennial Park among them. Most residents can remember having picnics on the beautiful grounds of this well-known park. The healing power of music is also represented throughout the center, using various forms of musical instruments.”

Other distinctive areas include triangular courtyards. One may even be used as an area for visitors’ children, officials said. There are also guest sitting areas in resident rooms, bedside hydration, in-room soiled linen bins and an entire wall made of glass to allow maximum natural light, Waldron said.

But every now and then an announcement comes along that reveals a fundamental shift. Actually, we’ve seen three lately.

The first was Brookdale Senior Living’s acquisition of Emeritus Corp. What makes this deal notable — besides the huge sum involved — is its strategic implication. Brookdale aims to discredit the traditional notion that senior living is not scalable. More to the point, it wants to do something that has never been done before: become a nationally recognized senior living brand.

The second development is still in flux. Kindred Healthcare has launched a hostile takeover bid in an effort to add one of the nation’s largest homecare companies to its rapidly expanding portfolio. 

The current management at Gentiva Health Services is dead-set against the move, so the outcome here is hardly settled. Regardless, there’s no denying the fact that a company that cut its teeth as a skilled care chain is now trying to become a homecare operator. Ten years ago, that move would have been laughed at. Now it’s increasingly being seen as an essential strategic adjustment.

Then there’s real estate investment trust giant Ventas. The firm took another big step toward bolstering its private-pay assets when it announced it would acquire American Realty Capital Healthcare Trust for $2.6 billion in cash and stock. The transaction is expected to be finalized later this year.

If/when the deal is consummated, Ventas will become the nation’s largest health REIT, and a global leader in senior living.

So, what are we to make of these moves? The obvious implication is that the bigs are getting bigger. But scale is only part of the story. They are also becoming titans that truly offer a diversified continuum of services.

Will such departures from the old ways work? Billions of dollars are backing up the proposition that they will. Regardless, the future is clear: Titans with capital will be doing everything possible to corner the senior living sector.

As for operators not running with the elephants? Let’s just say the so-called mom-and-pops may give “cottage industry” a whole new meaning. 

If you are reasonably confident that the old ways of doing things will continue be successful going forward, these shifts should give you a reason to think again. As never before, change is in the air.

Cognitive decline coupled with comorbidities factors heavily into operators’ pursuit of customizable, comprehensive and reliable security solutions. “Resident acuity is going up. Many residents have dementia and are at risk for dangerous wandering and [elopement] and other activities that could jeopardize their safety,” said John Brasch, president of Brasch Group Companies. Facilities must address these issues on the front end, rather than reacting after an incident takes place. When the latter happens, it can sometimes be too late, he stressed.

Operators needn’t look far for sophisticated, flexible, and increasingly cost-effective security solutions. From flexible wander management and fall detection systems to innovative nurse call and motion sensors technologies, and more, today’s offerings are limited only by an operator’s   imagination. The best part? Virtually all residents, regardless of their needs, can benefit.   

“Even though many seniors are still active and, for the most part, in good health, it doesn’t mean they’re not at risk for injury or confusion,” explained Donna Harris, director of marketing for SafetyCare Technologies LLC. “Having a robust and flexible solution in place allows a facility to keep all residents safe.”

Blended benefits

Among the greatest advancements in modern-day resident security technologies is the ability to combine multiple solutions into one seamless system. Now that many low-voltage systems utilize service and wireless-based systems, solutions providers are able to merge user interfaces and create a more streamlined experience, said Wes Columbia, manager of project services for Direct Supply Technology Solutions.

“As technology has evolved, systems have gone from simple pager systems to full, real-time locating-type systems that can track every resident and piece of equipment in a building.” Integration of EMR, billing, facility management, staffing systems and cloud-based wireless systems are also trends emerging in the senior living segment, Columbia said.

Silent alarms coupled with the ability to merge and manage different systems, such as access control, emergency call, wander management, fire panel, and more, within the facility under one centralized location are key advantages of today’s solutions. The clear trend is to push actionable information straight to caregivers so they can promptly respond to an event, according to Steve Elder, senior marketing manager, at STANLEY Healthcare. 

System compatibility and easy-to-use mobile-based technologies allow for simplified implementation. In the past, new techniques needed to be learned by residents when they went to an ALF, said Harris. 

“The implementation of less intrusive motion detectors, RFID, Bluetooth, and other devices means you don’t need to train users how to call for help,” she said. 

This helps eliminate false alarm rates triggered in the past when users didn’t learn the new way of checking in with staff in the morning to confirm everything was okay, she noted.    

Analyze needs

Before committing to a security solution, operators should first conduct a comprehensive needs analysis —one that takes into consideration clinical, environmental and facility management requirements, and, above all, keeps a community’s resident population in mind. 

Some residents may not need a mobile solution and will want to see staff as little as possible, while others may need additional care and attention. “Find a scalable solution that will help with both ends of this spectrum, and one that will grow with you over the years with minimal upkeep and cost,” recommended Harris.    

Using resident behaviors to guide system evaluation will go a long way toward minimizing implementation headaches and avoiding complicated systems that can frustrate staff and residents, added Columbia.  

Security solutions that offer individualized support are key to allowing residents of varying needs to stay in their current living environment. Wander management solutions are a prime example of how customization based on each resident’s unique needs can have a positive impact on resident safety and satisfaction. 

As Elder pointed out, innovative wander management solutions let residents maintain their current activities within the community, while offering silent protection in the face of danger. 

“It’s even possible to enable a spouse to escort a resident through monitored exits at certain times of day — say, to access a garden or other outdoor amenity,” he said. 

Data gathered by security technologies, such as wander management solutions, offers far more than just event notifications. 

“Forward-thinking organizations are mining this information to understand residents’ changing needs, and measure their own performance,” Elder continued. 

Sensor-based technologies are also allowing operators to pinpoint patterns and behaviors that could indicate physical or cognitive change and place residents at risk. Changes in sleep patterns, for example, have been shown to be early indicators of oncoming health issues, like urinary tract infections, medication issues, and other complications. 

“Changes in sleep can also be predictive of increased fall risk,” said Will Kaigler, president and CEO of NewCare Solutions LLC. With one plug-and-play sensor, the company’s SilentAlert Sleep Index Algorithm models each resident’s normal sleep patterns and emails the nurse of any significant changes. 

More than ever, sensor-based technologies are blending seamlessly into a resident’s home environment. The SafePresence Bedtime nTouch by the Brasch Group, for example, looks like a standard bedside clock, but is connected to a sensor pad in the bed to monitor if the resident is in or out of bed at an unexpected time. The system is passive, eliminating the need for the resident to press a button to send an alert for assistance. A pre-alert function allows the resident to touch the screen and avoid sending unnecessary alerts. If an alert is activated, a text is sent to the caregiver, so prompt action can be taken to ensure that resident’s safety.

“In the past, if a person got out of bed and fell and needed assistance, that person could be on the floor for hours, waiting for a caregiver to check in,” said Brasch.

Staff steers success 

Any security solution’s efficacy lies in broad-scale staff adoption and a facility’s willingness to use the information gleaned to improve resident care. Their use should not only make staff more efficient, but also more accountable for resident safety. 

“Family members of assisted living residents are more likely to choose centers where the environment is perceived as being the safest,” Columbia stressed. Security solutions that advance this safety-focused culture are key to success.  

The goal is not just central management of systems, Elder added, but “providing greater insight into what’s actually happening in their community.”

The annual costs of dementia care could more than double by 2040 if the age-specific prevalence rate of the disease remains constant as the nation’s population grows older. U.S. policymakers have made funding for clinical responses to dementia a priority.

“The majority of Americans’ cost-burden for dementia is caused by long-term care,” said Regina A. Shih, the study’s lead author. “As baby boomers reach the ages of highest dementia risk, the nation faces urgency in finding ways to improve long-term services and supports specifically for this condition. 

The study lays out five general goals:

• Increase public awareness of dementia to reduce stigma and promote earlier detection.
• Improve access to and use of long-term services and supports for people with dementia.
• Promote high-quality care that is focused on meeting the needs of individuals and family caregivers.
• Provide better support for family members who provide caregiving to people with dementia.
• Reduce the financial burden placed upon individuals and families who must pay for long-term services and support for people with dementia.

New legislation or changes to existing regulations may be needed to authorize some policies, such as a proposed expansion of home and community-based services. Other barriers may be operational, such as logistical challenges to linking together long-term care insurance and health insurance. In some instances, barriers may be political, such as expected opposition by some groups to a single-payer long-term care insurance system.

“There is no one single path that is the best one to follow to provide better care for people with dementia and improve support for their caregivers,” Shih said. 

Alzheimer’s disease is the most common form of dementia among older people. About 4.5 million Americans suffer from this debilitating condition.

1. With my Medicare and Medicaid entitlements, aren’t almost all of my future healthcare costs covered? Obviously an erroneous assumption. A senior consumer or their family’s future private pay exposure can be significant.
2. Private healthcare insurance is getting very expensive. Do I really need it? Efficiently operated assisted living or possibly a comprehensive CCRC with life care options is frequently the correct answer.
3. Can’t most of my future healthcare needs be provided in an affordable manner at home?  This may be initially true, but the aging process frequently results in higher acuities. The skills of a typical companion or homemaker are rapidly exceeded.  
4. It appears that living in a retirement community is much more expensive than staying right here at home.  Am I correct? Not necessarily true. A surprising majority of seniors have significant misconceptions regarding their true annual cost of living versus the pricing of well run, market-responsive retirement communities.
5. Is there a way to control my future healthcare costs so I don’t spend-down my life’s savings? If a prospect is initially income-qualified for a well-run community, their likelihood of experiencing significant spend-down is relatively remote. Many operators also have a menu of options to avert future spend-down such as unit downsizing, reducing the future entry fee refund obligation for a CCRC and possibly charitable content funding for a not-for-profit.  
6. Some entry fee communities charge quite a bit. Won’t I seriously reduce my current net worth if I decide to move to one of them? Frequently this is a classic example of short-run thinking. Most seniors do not pay entry fees with their current actual net worth. Most sell a home and pay their entry fee from new cash from their home sale. Very frequently a senior’s current active net worth (before the home sale) is not significantly impacted.  
7. If I pay a big entry fee, how will I be able to leave a legacy to my children and grandchildren?  Upon death, a senior may have a refundable entry fee of up to 90% of his or her original payment.  This can provide a living financial legacy to their children or grandchildren. The initial entry fee payment might also provide substantial life care benefits in the form of significant cost reductions to cover their future healthcare financial exposure. There can also be a substantial tax benefit to the consumer of a one-time medical tax deduction of 30% to 35%.  
8. Are there any special income tax deductions available for some healthcare costs? For a moderate $300,000 entry fee that involves life care, that one-time deduction would be in the range of $90,000 to $105,000 with tax loss carry back and carry forward financial options.
9. If I live in an assisted living community, are there any tax benefits? Yes. If you are receiving assistance with at least two Activities of Daily Living or require substantial supervision because of cognitive impairment, you can potentially deduct almost all of the full monthly service fee; shelter, services and care. IRS Publication 502 (www.irs.gov) provides the details.
10. Will my children or my financial advisor understand all these FAQ details? Probably not. Most of the answers to the FAQs seem like basic common sense that the senior consumers, their adult children or financial advisors already know. Not true.  Many either have not considered them or have not put them in proper perspective.

“The Elder Justice Roadmap” defines elder abuse as any “physical, sexual and psychological abuse, as well as neglect, abandonment and financial exploitation.”

Most adverse events in nursing homes are largely due to inadequate treatment, care and staffing — leading to a 22% increase in unnecessary hospitalizations and costing Medicare $2.8 billion, the report stated.  

To form a plan on how to combat elder abuse in long-term care facilities, as well as in all senior residential settings, 750 practitioners and leading experts were asked to complete the following sentence: “To understand, prevent, identify or respond to elder abuse, neglect, or exploitation, we need…” 

The following top five priorities were identified: 

1. Increase public awareness of elder abuse
2. Conduct further research on mental health and cognitive capacity issues 
3. Provide better training and support for caregivers
4. Quantify costs of elder abuse
5. Invest more resources in services

In addition to these priorities, the government initiative calls for stronger monitoring of services, policies and oversight through survey, licensing agencies and the development of law enforcement and prosecution units that specialize in elder abuse.

“The Roadmap Project is an important milestone for elder justice,” said Associate U.S. Attorney General Tony West. 

“Elder abuse is a problem that has gone on too long, but the Roadmap Report released today can change this trajectory by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multifaceted dimensions of elder abuse and financial exploitation,” he explained. “While we have taken some important steps in the right direction, we must do more to prevent elder abuse from occurring in the first place and face it head on when it occurs.”

The initiative was funded by the U.S. Department of Justice with support from the Department of Health and Human Services. In further support of the initiative’s mission, the DOJ created an interactive, online curriculum for attorneys and the HHS developed a voluntary national adult protective services data system, DOJ announced.

Garden therapy

Individuals with advanced dementia had better behavior after viewing a Japanese garden in their senior living center, researchers have found. 

Seiko Goto, MA, Ph.D, and fellow researchers from Rutgers University conducted the study to compare responses to two sensory environments in a nursing home: a multisensory Snoezelen room and a temporary Japanese garden. 

The researchers measured residents’ stress levels according to behavior and heart-rate changes while viewing a sensory environment for 15 minutes twice a week. Participants who viewed the garden had more positive behavioral changes while those who viewed the Snoezelen room showed more negative results. 

Pulse rates were significantly lower in the Japanese garden than in residential rooms, but there was little to no change between being in the residential room and the Snoezelen room.  

Residents also started showing negative behavior when the Japanese garden room was changed to include plants and furniture installed with no design.

Results from a previous study conducted by Goto and a different research team from Rutgers University supported these findings. Of the three landscaped places — an herb garden, a simple landscape with a single tree and a Japanese garden — structured gardens evoked greater responses in measurements of heart rate, sympathetic functions and mood. 

Findings from the most recent study were published in the Journal of Alzheimer’s Disease.

Questioned surgeries

About one-third of knee replacement surgeries in the U.S. were classified as “inappropriate,” which is higher than expected, Virginia researchers assert in a new study. 

The data support the need for “consensus development of criteria for patient selection” among U.S. practitioners who treat candidates for knee replacement surgery, the researchers said.

Daniel L. Riddle, Ph.D., and his colleagues from the Virginia Commonwealth University in Richmond, conducted the study using data from 205 people who had undergone total knee arthroplasty surgeries. 

Each individual was enrolled in the Osteoarthritis Initiative, a prospective 5-year study sponsored by the National Health Institute. 

The researchers then used an appropriateness classification system to classify each surgery as “appropriate,” “inconclusive” or “inappropriate.” 

They also used pain, physical function, knee motion, laxity, age and radiographic measurements. The average age of a person in the data set was 67 years and 60% were women. 

Results showed that about 44% of the surgeries were appropriate, about 22% were inconclusive and about 34% were inappropriate. Based on previous evidence and research, the hypothesized prevalence rate for inappropriate classifications was 20%.

The Agency for Healthcare Research and Quality reports more than 600,000 knee replacements are performed in the U.S. each year. 

The AHRQ estimates an 85% increase in knee replacement surgeries by 2030.

Full findings appear in Arthritis and Rheumatology.

In a session on what CIOs and nurses have learned since the paper’s release, panelists spoke about how “Electronic Health Record Solutions LTPAC Providers Need Today,” can lead to better caregiving. The June summit was held in Baltimore. 

The paper posits that senior living organizations should have systems “built on the foundation of a single integrated EHR engine within which any real consumer/patient has a single identity against which structured, document, and social (interaction/conversation) information is recorded.” When information is recorded it should “obviate prior processes and downstream redundancies.” 

Many clinicians try to “fit” their care delivery process or workflow into the EMR modules, such as putting assessment components beyond the MDS in different modules. 

“This lack of alignment between clinical care delivery and the existing EMR modular configuration causes disruption in workflow and results in development of ‘work arounds,’ thus negatively impacting productivity and causing a myriad of unintended consequences,” the paper reads.

Over the past year, the document “has opened dialogue on the clinician side and allowed us to continue a more positive dialogue,” said panelist Debbie Jones, RN, LNHA, CEO of New Beginnings Care. Some vendors have seen the paper as a critique, but others have embraced it and used it as a motivator, Jones and other panelists noted. Providers need help from vendors to achieve interoperability and allow clinicians to have more control over viewing data, Jones said.

“The paper needs to evolve as we evolve, and should reflect your feedback,” noted Richard L. Castor, the senior vice president and chief information officer at Genesis Healthcare.

The bottom line is that technology needs to be easy for clinicians, reminded panelist Jillene N. Snow, RN, BSN, MBA, CHCC, the senior vice president of compliance and clinical information at Ethica Health and Retirement Communities.

“We forget that at the end of the day, it’s people taking care of people,” she told McKnight’s. “Nurses and nursing assistants want to take care of people. Technology has to be easy, and we try to help in making technology their friend.”

CFOs target Internet

Executives are typically allocating between 2% and 3% of their operating budgets for technology, according to a recent Ziegler survey. More assets are devoted within the capital budget, with an average of 12% of those blueprints devoted to technology. 

More than 130 chief financial officers participated in the survey, with 58% of them from single-site organizations.

Respondents said they are investing more in technology since the last poll in 2012. The largest proportion of organizations said they are investing in technology infrastructure, such as high-speed Internet or wireless networks, as well as increasing resident access to the Internet. 

One person wrote, “All of our buildings are situated in rural areas so in order to bring more technology into our buildings, we must have reliable/redundant Internet and fail-safe IT infrastructure.”  

Executives said those initiatives, as well as investing in electronic health and medical records, top their list of anticipated expenditures. One respondent noted that technology is becoming a large organizational operating expense, particularly with “the growing advent of EHR considerations.”

Facebook appeal fails

A former senior living worker fired for a Facebook status update has not succeeded in an appeal to the Idaho Supreme Court. The language of the skilled nursing facility’s social media policy was an important factor in the ruling handed down in June. The worker wrote that he wanted to “slap the ever loving bat snot out of a patient” at the 60-bed Desert View Care Center in Buhl, the Twin Falls Times-News reported. 

Replacing passwords

Free-form gestures, such as sweeping fingers in shapes across the screen of a smartphone, may be a better way to protect personal or confidential information, according to a new Rutgers University study. The gestures are less likely than traditional passwords to be observed or reproduced, according to researchers in the School of Engineering’s Department of Electrical and Computer Engineering. The researchers planned to release their work around MobiSys ’14 in June, which is an international conference in mobile computing.

Toward better data

Senate Finance Committee Chairman Ron Wyden (D-OR) and Sen. Charles Grassley (R-IA) have asked providers for more transparency in healthcare-related data. The letter asked for comments by Aug. 12 on how to make the data “more useful and readily available.” Wyden and Grassley previously introduced the Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act) to make the Medicare claims database available to the public at no cost.

Pieces that create a comfortable, welcoming atmosphere are key for conveying a “home-like” environment instead of a medical setting. Aesthetics are definitely a top criterion in selecting the appropriate furnishings. Yet attractiveness is not the only consideration — long-term care facilities also must assess how the furnishings are used and maintained.

That is why manufacturers are increasingly focusing on creating the right balance between aesthetics and durability, says Michael Zusman, CEO of Kwalu. The chief concern, he says, is a resident population that is older, frailer and more vulnerable in the senior housing market.

“The rise in acuity levels of residents has been a game changer, especially for those facilities in independent living, assisted living and memory care,” Zusman says. “More often, these residents are suffering from dementia and likely need a walker or wheelchair. This has forced providers to look for more durable options for furniture because the typical wooden chairs and tables are simply not holding up.”

Kwalu’s priorities have been to create pieces that have visual appeal while incorporating a solid construction that can withstand the repeated punishment of knocks from carts, walkers and wheelchairs, Zusman says. 

The “Designed to Last” product line carries an upscale image but incorporates more material to protect fabric and chair arms against knocks and overall wear-and-tear, he explains. Additionally, extra handgrips at the tops of the dining chairs are designed to make it easier for caregivers to move the chairs around.

Aesthetics, stain resistance and durability are the focal points at Herman Miller. Chris Silguero, director of the company’s Contract Division, says the three characteristics “are all vying for the top spot.” The company’s overarching mission, he says, has been to provide furnishings that create a home-like environment that is warm in appearance and touch, yet is built to fit the tough needs of long-term care residents.

“Ultimately, we want an aesthetically pleasing, durable product that is functional in the most intense environments,” he says. “We use krypton fabrics, which give an element of stain resistance. Amazing progress has been made in the touch and look of these fabrics, which allows for us to accomplish all three of our objectives.”

Although the rising acuity level has not changed the way Herman Miller makes furniture, Silguero says it has “opened us to additional designs built to address this rising level.  Over the course of the next several months, we will be launching products for this purpose.”

More durability needed

The “typical wood chairs” that have long been staples of the eldercare environment are no longer serviceable in today’s facilities, Zusman believes. Jack Armstong, vice president of business development at Cooltree, agrees, noting how chair arms bear pressure as the resident uses them to stand up. This causes pieces of a wooden chair to separate and potentially leads to a fall or injury. 

Wooden chairs also don’t do well at absorbing the bumps and scratches inflicted by wheelchairs or medical equipment, he says.

“Operators simply can’t ignore the liability issues caused by a fall or the unsightliness of scratched or gouged chairs,” Armstrong warns. “Long-term care providers should seek out nonwood chairs that closely resemble wooden seating. Look for a durable chair that will provide stability for the resident on sitting and standing, which will instill confidence that the chair will not break or tip.”

Advancements in polymer technology have yielded stronger materials in furniture, making it last longer while offering a wider range of styles, Zusman says.

“As designers saw a need to continue the beautiful design in all areas of a facility, they began to understand the benefits of polymer-based furniture options,” he says. 

“It seemed to them that wood could not withstand hard use or frequent cleanings. Metal is too cold and ergonomically stiff for the time spent sitting in a resident room, or lounge and lobby areas, for long periods of time.

“Designers found that durable, ergonomic and aesthetically pleasing furniture and seamless furniture design are equally important as residents move from one level of care to another. Hence the development of more diverse furniture options that suit the needs of a total campus.”

Another facet of toughness and durability is size, says Jacki Zumsteg, manager of design operations at Invacare Interior Design. The nation’s obesity epidemic includes seniors, and bariatric versions of standard chairs are now as commonplace as mobility- and bath-safety equipment, she says.

“We have seen more of a demand for products that have higher weight capacity,” Zumsteg acknowledges.

The choice of furnishings depends on which rooms they will serve, she notes. Furniture in rooms designed primarily for visitors could be standard-sized and don’t necessarily need heavy-duty construction or special features, she explains.

On the other hand, “When residents are the primary users, as opposed to visitors, we suggest seating products with clean-out or removable seat cushions for easy cleaning,” she says.

Cleaning hazards

Although furniture manufacturers are concentrating on making furnishings that are not institutional in nature, the fact remains that long-term care facilities’ furnishings are subjected to much heavier usage, cleaning, moving and general wear-and-tear than they would receive in an ordinary residence. 

Zumsteg notes the manufacturer’s challenge is to meet the critical triple-pronged criteria of aesthetics, stain resistance and durability.

“In a senior living environment, stain resistance and durability are important components so that the products will last and continue to look great for years to come,” she says. “Aesthetics is important for the marketing aspect of the buildings. When showing the property to prospective residents’ families, you want everything to look great.”

Even so, caustic cleaning elements such as disinfectants can pose a threat to furniture’s fabric, finish and function, Zumsteg says, adding that “we have responded by making our finishes resistant to withstand the harsh chemicals used to clean our products.”

Housekeeping can unintentionally damage furniture during cleaning sessions, Silguero says.

“Vacuum scuffs and cleaning solutions that are not wiped off completely are two of the most common threats,” he says. “As a result, we are introducing a collection of laminate furniture that will be better suited to resist denting and scratching because it’s not wood. The appearance will be that of wood, but the materials are comprised of laminate material.”

Geography matters

Where a facility is located can make a difference in what types of furnishings should be used. 

Certain materials that work well in the arid heat of an Arizona facility, or for a place in a high-altitude alpine climate, might not be suitable for the heat and humidity of New Orleans or Florida, Silguero points out.

“There are absolutely product designs that play better in certain geographies than others,” he says. “Although materials are mostly affected by humidity, they are not typically affected to the point of non-performance. For those in the northern states, for example, during the winter months, wood will swell. This is taken into consideration in the engineering of our products, which allow for wood to react to its environment while maintaining its structural integrity and functionality.”

Zumsteg agrees that location can make a difference for the styling of furniture, but adds that for the manufacturing of the furnishings, “they are typically designed for the normal range of temperatures.” n

Complex and chronic wounds such as pressure, venous, arterial and diabetic foot ulcers continue to challenge the eldercare industry. They are hard to heal and can be a significant drain on resources and nursing time.

Additionally, the rising prevalence of lifestyle-related diseases such as diabetes and obesity that result in chronic wounds nearly guarantees that the need for innovative products and strategies for wound care will only continue. 

Advanced wound care products, including alginates, hydrogels, hydrocolloids and collagen, increasingly are emerging as the standard therapy for treating such slow healing wounds. Effectiveness in preventing accumulation of excess exudate must be balanced with maintaining the right level of moisture. 

In some ways, though, negotiating the myriad wound care options has become as much of an art as a science these days. New discoveries, including skin substitutes and biological growth factors, continue to advance the field. At the same time, third-party, large-scale research comparing the effectiveness of various products — particularly among eldercare residents — lags behind, says Judy Bolhuis, BS, LNHA, vice president of post-acute care at Ferris Manufacturing Corp. 

Therefore, it’s typically incumbent on clinicians to customize their wound care plan based on an individual resident’s needs. 

Nursing homes also are constrained by cost, notes Diane Krasner, Ph.D., RN, FAAN, a wound and skin care consultant and part-time nursing instructor in York, PA, and editor of “Chronic Wound Care: The Essentials” (2014).

“The bottom line right now is that the technologies and products that are the least labor intensive and the least expensive and the most user-friendly are the ones that are going to have the most impact in this environment,” Krasner says. “So while there are wonderful products that may be developed, usage often falls back to the old standbys because they’re inexpensive.”

New advancements

Given the high incidence of wounds in the healthcare setting, and their associated risks, it’s understandable why researchers continue to devote time and effort to studying new technologies in wound management and prevention. Roughly 6.5 million people are affected by chronic wounds, and an estimated $25 billion is spent annually in the United States on treating them.

Some of the most innovative wound care advancements have been in the area of cellular- and tissue-based product development, and biologic and biosynthetic dressings, says Bolhuis. She notes that skin substitute products present a novel approach to wound care. Collagen dressings, for example, are naturally derived, stimulate new tissue growth, and encourage the deposition and organization of newly formed collagen fibers and granulation tissue in the wound bed. Many also contain an antimicrobial agent such as silver — a way to control pathogens within the wound, Krasner notes.

New evidence also is emerging with regard to the development of a tissue-engineered human skin substitute. According to a study published in October in Advances in Skin and Wound Care, Canadian researchers successfully healed venous ulcers with human skin grown in vitro. The study was conducted with five patients who had been unresponsive to conventional wound care treatments such as compression bandages. 

And in November, an Iceland-based healthcare startup, Kerecis, received U.S. Food and Drug Administration clearance for its fish-skin treatment. It takes cod skin and removes all the cells and antigens. Fish skin is largely made from the same material as human skin, with the addition of Omega3 polyunsaturated fatty acids — which have long been known to reduce inflammation. When the product is inserted into or onto damaged human tissue, protease activity is curbed, the fish skin is vascularized and populated by the patient’s own cells, and it is ultimately converted into living tissue, the company notes.

Time for trials

Much tissue-based engineering has been studied only with small patient samples, but Bolhuis notes, “some of this research is so ready to be trialed in a larger market like long-term care.”

Experts also have seen increasing interest in placenta-based tissue, or amniotic membrane allografts. These often contain many of the growth factors found in the cell-based products, but they can be used right off the shelf, notes Margaret Falconio-West, BSN, RN, APN/CNS, CWOCN, DAPWCA, senior vice president of clinical services for Medline Industries.

“With many of the cell- and tissue-based products, there’s time and effort taken into preparation, and they usually require special handling and storage conditions,” Falconio-West says. “Wound care and long-term care facilities are busier than ever, so room temperature storage, multi-year shelf life and no prep work required are huge advantages with some of these new placenta-based grafts.”

“Self-adaptive” or “smart” wound dressings are another innovation. Healing needs shift dramatically and sometimes unpredictably from wound onset to later stages, says Vicki Fischenich, RN, MSS, GNP-BC, WCC, a clinical specialist for OSNovative Systems. Self-adaptive dressings sense moisture levels and automatically create optimal healing conditions, hydrating dry areas and absorbing excess moisture. They only need to be changed about once a week.

“The less you pull off the dressing, the less you alter that ideal wound bed temperature, which leads to better outcomes,” Fischenich says.

Another trend has been the demand for preventive care, says Paula Erwin-Toth, MSN, RN, CWOCN, CNS, FAAN, a clinical consultant for MediPurpose. She notes that some studies support the use of foam-based dressings in the sacral region as part of a prevention protocol. Other research has focused on broad-spectrum silver and other antimicrobial dressings, including Manuka honey, to treat biofilms and prevent local wound bed infections, though results have been mixed.

“The science and practice of wound prevention and treatment is continually evolving,” Erwin-Toth says.

Keeping it simple

More than any product trends in wound care, however, the biggest shift Falconio-West says she’s seen recently is a return to basics.  

“Practices like hand hygiene, which is well documented as a first line of defense for infection prevention, are not as good as they should be, so refocusing on simple tasks like that are emerging,” she says. “Understanding the basic principles of wound healing will also take the clinician down an appropriate path to choosing the correct type of dressings.”

The Bottom Line

Joe Flaherty, M.D., professor of geriatric medicine at Saint Louis University, agrees, noting that while dressings are important, healing can happen only when the underlying wound cause is corrected. What really matters is whether nurses and staff follow the basic principles of wound care — pressure relief and keeping the wound clean and moist. 

“After reviewing the data, we really haven’t found much difference in various products,” Flaherty says. “That doesn’t mean people should be afraid to try a new product, but you don’t want to let the new product supersede the basic principles, because that’s what really heals wounds  —  it just takes some time.”

Witnessing the residents and families being properly cared for were their rewards! My grandparents have both since passed on, but I know in my heart that they are proud of their two sons and grandchildren for carrying the torch forward in the fast-paced evolution of today’s senior housing. How we understand our residents’ needs is the most important thing we can do.

I would like to share with you an idea about understanding needs and one of the most pivotal parts of my personal philosophy about caring for seniors/retirees. That is: “TRY TO TAKE CARE OF THEIR PARTICULAR NEED BEFORE THEY ASK.” It’s a self-taught, nurtured philosophy that relies on perception and the uniqueness of an individual or group. The thesis is based on profiling the most likely needs based on how I would want to be cared for. 

Here is a simple example of how the process works. I have been around boats my whole life and enjoy water skiing with friends. When I set up a day to do this, first, I have to profile who’s going skiing by using obvious biological, sociological and psychological factors. Then I go through a process of elimination determining the five biggest possible factors to be aware of on the day of the trip. For example, if it’s going to be 105 degrees outside, then that’s how I base my mental plan, while assuming my friends will be 50% prepared. It’s my boat, so I feel responsible to them. 

First, I make sure the Bimini top is on the Bayliner to provide shade. Second, I prepare a cooler with enough ice, Gatorade and water for everyone. Third, I bring a good selection of sunblock to share. Fourth, I have several light color hats/shirts available to cover up with, and fifth, a fan that circulates the air I made that runs off the motor (Don’t ask.) If I follow my plan to a certain degree of error, it makes the individual’s percentage of not overheating higher. The same processes can be applied to [running] a retirement community.

John P. Rauls is the vice president at Southeastern Retirement Management Inc. He is a third-generation senior living professional.