Metamorphoses: Identifying Trends in Senior Living

        By Robin H. Eggert

        Kaizen is a Japanese word meaning continuous improvement. The Japanese have fully absorbed this concept that “finished never is” into the corporate culture of their most successful businesses. “The spirit of kaizen,” comments international management consultant Kiyoshi Suzaki, “begins with the acceptance that the status quo is not perfect.”

        Getting Out of the Box

        For years acceptance of the status quo proliferated in the long-term care industry. Energy was focused on:

        • Maintaining the structure
        • Conservation rather than innovation
        • Playing “not-to-lose” rather than to win

        The industry as a whole blamed regulations, government, and reimbursement rates on their inability to dream—they were unable to “get out of their box.”

        Complacency always provides opportunity for visionaries. By exercising their creative talents, these trail-blazers have been able to break the mold, to “get out of the box,” to dream of alternate ways to provide services to our aging population.

        America’s rising tide of frail elderly further enhances opportunity. The number of elderly over age 85 is expected to double, to more than 5.6 million, by 2010. Looking even farther down the road, the US Bureau of the Census projects the number of elderly over age 85 will increase from about 3.7 million in 1996 to between 18.2 million and 31.1 million by the year 2050, depending on mortality levels.

        From “Care” to “Living”

        The major trend in serving our aging population has been a paradigm shift from caring for our seniors to encouraging them to live a fuller, more independent life. Consumers have abandoned the notion that they have no other choice in supportive services housing than the highly regulated nursing home. As a society, we have historically relied on government to provide our aging health care needs. Furthermore, we have expected that the government would safeguard, through regulations, the environments in which these services were provided.

        Backed by powerful coalitions, such as the American Association of Retired Persons (AARP), consumers have reclaimed their right to live with dignity and independence in their later years by demanding personal control and choice. They want to be treated as a whole person—body, mind, and spirit. In turn, the aging population is taking responsibility for how and where they will live—their health habits, health care, the places in which they live, and lifestyle. Programs and environments which respond to the consumers’ desire for choice define the current trends in the aging market.

        Trends Present More Options

        Just a few short years ago, stability was the byline of the long-term care industry. When old people needed care, they went to a nursing home. In the last decade alone, dramatic changes have occurred. The most recent National Long-term Care Survey shows a decline of approximately 10% in the use of nursing homes. When comparing the five-year span 1989 to 1994 with the previous Survey study period, we see a dramatic shift in recognizing alternatives to nursing home care. More and more, frail seniors expect to stay at home, or at least in less institutional settings, as age takes its toll. This trend, coupled with a more educated and demanding consumer, has nursing home providers shaking in their boots.

        Traditional nursing home owners are rightfully confused, frustrated, angered, and frightened by these new market conditions. They grapple with questions that could mean their ultimate survival in the industry: What is going to happen next? Shall we change the focus of our care structure to subacute, or assisted living, or even managed care? Perhaps we’ll wake up one morning and it will all go away, so is it safer to continue struggling within the current system?

        Don’t Count On Big Brother

        One of the overriding issues today is not whether government financing will continue to reign in long-term care, but how quickly and smoothly the transition to private financing will occur. Even the staunch supporters of federal programs that serve and protect the elderly recognize the obvious—the government is broke! This is evidenced by the disastrous fiscal condition of Medicaid and the impending fate of Medicare and Social Security. Further compounding the situation is the oncoming demographic steamroller of the baby boom generation who will expect, but not receive, the same level of support on which their parents have counted.

        Alternative Care

        Many long-term care providers will be buried along with the old system. Others will prosper with the new. Here are four market areas that are expected to grow and prosper as the aging population demands alternatives to the traditional nursing home environment.

        Managed Care

        As managed care has entered the marketplace, it has become the major influencer of future trends. The path toward managed care is forcing providers of aging services to look beyond their walls to an integrated service delivery system. From the minute a patient enters the system, everyone must know the discharge goal, and it must be a unified approach. Is the goal to get her back home? Into an assisted living? How many days are there to achieve the outcome? Managed care companies expect patients to be returned to the community at a reasonable cost, in a safe condition, and at a higher functioning level.

        Subacute Care

        Now positioned as the primary option which will allow managed care companies to maintain quality and reduce acute care costs, subacute care is poised for explosive growth. Prime for the change, managed care is now taking on risk for enrollees with a higher portion of chronic conditions. Subacute care has changed forever the way traditional nursing homes will go about their day-to-day business.

        Assisted Living

        Today’s assisted living providers have been forced by the ever-increasing acuity level of residents to consider better ways to deliver ancillary services. As residents become participating partners in their health care, services such as pharmacy, home health, rehabilitation, hospice, and geriatric psychology are all experiencing changes in delivery. Rising astuteness on the part of the service recipient obligates the provider to confront the demands for higher quality health care. Savvy providers realize that, by leveraging ancillary services, they can expand their resident mix. This permits residents to remain in their communities longer and delays the transfer of residents to institutional settings. If not properly strategized, the short-term benefits of permitting “aging-in-place” can lead to serious long-range problems, such as:
        • Annually increasing the average resident aid and frailty level.
        • Having a facility with a large percentage of the population requiring ambulatory assistive devices, i.e., wheelchairs, walkers, etc.
        • Not projecting adequate space for services, such as dining, which could force providers to offer extra seatings and, in turn, increase staffing needs.
        Designing a facility to handle the higher percentage of residents with cognitive impairments.

        Alzheimer’s Assisted Living

        Currently, the estimate of Americans identified with Alzheimer’s is approximately 4 million. As the population ages, cases of Alzheimer’s are expected to increase dramatically. By the year 2000 the number is projected to rise to 7 million. Ensuring that the needs of this burgeoning case load will be met will be a substantial challenge to care providers.

        Assisted living is an environment-of-choice for early- to middle-stage Alzheimer’s. It could take years for patients to manifest the more serious medical problems typically evident at the later stages of the disease. At this time, a higher level of care is required. Initially, the physical surroundings of a facility weighs heavily in the selection of an assisted living for a relative with Alzheimer’s disease. But the importance of such criteria as home-like appearance fades once the resident has moved in. By then, says a report published in February by the Alzheimer’s Association, loved ones’ attention turns to staffing and how well services are targeted to the resident’s individual needs.

        Get the Big Picture

        Taking a big-picture view of long-term care requires vision and the ability to transform the provider organization—continually metamorphosing to meet the ever-changing needs of the more astute aging population. While some providers are focusing on the day-to-day facility operations, others are taking a global perspective of packaging services and methods of saving money. In order to facilitate these transitions, those serving the aging markets must continually ask themselves, “What business am I in and how can I be the leader in my industry?”

        In five years the senior care trends discussed here will no doubt be supplemented or replaced with a whole new focus. Equating advancements in senior care to trying to keep up with the latest computer technology—there is no such thing as state-of-the-art. We are merely capturing a moment in time and, at best, will accomplish state-of- the-minute. Remember the spirit of kaizen: finished never is.”