Seniors Housing Business is the magazine that helps you navigate the evolution of the seniors housing industry.
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are making it diffcult for provid- ers to offer high-quality care in a more cost-effective setting," says Handelson. "The whole (regula- tory) situation perplexes me." Belmont Village Senior Living licenses all of its units for assisted living, including those meant for independent living residents. "We run all our buildings the same," says Patricia Will, presi- dent and CEO of Houston-based Belmont. The average age of a new Belmont resident is 85, though the average age of current residents is 87 across the compa- ny's portfolio of 24 buildings. "We license all our units, so we can deliver assisted living care," explains Will. "It's turned out to be a valuable approach." All units are constructed to assisted living standards. Licensed nurses are available at every building around the clock. This practice by Belmont occurs even in California, where regulations do not require that level of staff- ing. The approach does result in higher construction and staffng costs, acknowledges Will, but it allows residents to age in place. The approach also helps Belmont accommodate couples who age at different rates. Belmont can pro- vide extra care in the unit for the needier spouse, thereby forgoing a move to a different section of the building that would separate the couple. "We are in a need-driven busi- ness," says Will. "The socializa- tion and hospitality aspect of our industry is important, but we have to be prepared to pro- vide a therapeutic beneft to our residents." Advances in technology Technology plays an increasing role in the management of acuity creep. Wi-Fi is available in many buildings to connect caregivers, families and supervisors. Medica- tion management systems and other automated care practices are being introduced in seniors housing settings. A number of software compa- nies offer solutions for buildings. Toronto-based PointClickCare, for example, provides a cloud-based software platform that includes a number of modules for medica- tion management, nurse's notes, intake and referral, risk manage- ment and rehospitalizations. To address acuity issues, one module enables building man- agement to capture the actual amount of time caregivers spend with each resident. Caregivers log their time on a kiosk in the hall or on a mobile device. Time spent caregiving tends to lengthen as residents age, a fact that often isn't captured, accord- ing to Jayne Warwick, solutions specialist at PointClickCare. The time-tracking module records services rendered that can then be billed to the resident. To avoid the possibility that families could be blindsided by big unexpected bills, Warwick says the extra time is not auto- matically billed and must be authorized. But having the data available regarding the amount of caregiving time provided gives the building manager an oppor- tunity to start a discussion with the family about the resident's real needs. "Building managers can have more intelligent conversations with families about the cost," she says. Open communication with the family is key to managing acuity creep, building operators say. Families should receive progress reports to forestall problems when the elderly person needs additional care or must be moved. Litigation worries Liability remains a nagging fear. The operator of an indepen- dent living building was sued after a resident, who had her own privately contracted aide, regularly wandered unattended to a nearby store. Since she was renting an independent living apartment, the building had no obligation to provide supervision. However, that didn't prevent the fling of a lawsuit. Other building operators have been sued on the basis of disabil- ity discrimination after evicting residents whom the building could no longer handle within the bounds of state regulations. Gray areas exist. Many inde- pendent living buildings have emergency call systems. Does that imply that the building is responsible for the elder who calls for help? A notorious California case in which a staffer refused to admin- ister CPR to a resident because of building policies resulted in a new law that requires assisted living facilities to have someone on staff 24/7 trained to provide CPR. The law also prohibits a building from having a policy that might keep a staffer from giving CPR. "You can't prevent the possibil- ity of a lawsuit," says attorney Paul Gordon, partner at Hanson Bridgett, a San Francisco law frm that works with seniors housing providers. But contracts should be carefully drafted, he notes. Independent living agreements should include a provision stat- ing that the building does not provide any care, and if care is needed that the resident or family is responsible to provide that care. Providers must carefully explain to residents and families the limits of care — what the facility can and can't do based on how the facility is licensed. Buildings should develop a comprehensive set of policies and procedures to mitigate high-risk situations, says Gordon. These high-risk situations include falls, a wandering resident who leaves the premises, cognitive decline and how to respond to emergen- cies. Policies should also be com- municated to any third-party pro- viders working in the building. "The facility needs to manage the high-acuity residents," says Gordon who sounds this warn- ing: "If you're not diligent, your residents will conspire with you to stay longer than they should because they don't want to move either." n Belmont Village Sabre Springs, in San Diego, includes both independent and assisted living units, but all units are licensed for assisted living. "Building managers can have more intelligent conversations with families about the cost," says Jayne Warwick, solutions specialist, PointClickCare. "If you're not diligent, your residents will conspire with you to stay longer than they should because they don't want to move either," says Paul Gordon, Hanson Bridgett. About the writer Jane Adler is a freelance reporter who has covered seniors housing for more than 10 years. She reports on the industry as well as consumer trends. www.seniorshousingbusiness.com 53 February-March 2015 n Seniors Housing Business