5 big issues in senior living in 2016

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Looking back on our coverage of the senior living industry and the issues that affected it in 2016, several common themes emerge. Five are detailed in this year-end review.

1. Staffing

Senior living operators took several approaches to solutions as they continued to struggle with ensuring an adequate, high-quality workforce in 2016.

Ecumen, for instance, conducted a two-year pilot study that exposed CNA, LPN and RN students from community colleges, technical colleges and state universities to the possibility of careers in senior living by welcoming them for clinical rotations at 10 senior living communities in rural areas in three states.

Vi at Bentley Village in Naples, FL, served as a clinical rotation location for gerontologic nursing students from nearby Florida Gulf Coast University's bachelor of science in nursing program. (Pictured above: Vi at Bentley Village's Sophie Clark, LPN, right, works with FGCU student Caroline Dixon.)

Elsewhere in Florida, Edgewater Pointe Estates of Acts Retirement-Life Communities, Boca Raton, was seeing improved retention and performance among new hires and improved morale among existing employees after implementing a new recruitment, interviewing and selection process.

Meanwhile, four Michigan senior living communities became partners in a $6 million federal grant designed to address healthcare workforce needs in the western part of the state. They have committed to helping colleges refine and develop program curriculum; offer internships, tours and interviews, and hire participants; and help identify additional positions they need to fill that might require training.

In Virginia, a new partnership between senior living community Friendship and Averett University was launched to make undergraduate and master's degree education as well as continuing education more affordable and convenient for the community's more than 700 staff members as well as their spouses and immediate family members. The program focuses on nursing and business administration programs.

The country's largest senior living provider, Brookdale Senior Living, launched a new student loan reimbursement program, which provides up to $7,000 for new hires, to attract nurses interested in the business side of healthcare.

Juniper Communities implemented its new 15X20 program, which has the goal of increasing hourly minimum wages in its communities to $15 by the year 2020.

See more workforce-related news here.

2. Regulation and oversight

Almost half of the states changed regulations, statutes or policies affecting assisted living between January 2015 and June 2016, according to the National Center for Assisted Living's 2016 “Assisted Living State Regulatory Review,” issued in October.

Utah in March became only the second state, and the first state in more than a decade, to require assisted living communities to grant resident requests to install cameras in their rooms. Missouri also considered camera legislation in 2016, but the effort did not go far.

Aides in some states obtained more responsibility under new laws. In Tennessee, for instance, medication aides working in assisted living communities, skilled nursing facilities and Programs for All-Inclusive Care for the Elderly will be able to administer controlled substances as of Jan. 1 under a law passed in April. And in New York, advanced home health aides working at some assisted living communities will be able to perform certain advanced tasks, such as administering routine or prefilled medications and helping with medical equipment.

See more state news here.

As 2016 comes to a close, senior living operators across the country are awaiting the finalization of transition plans detailing how various states plan to implement a final rule covering the provision of home- and community-based services, which was issued by the Centers for Medicare & Medicaid Services in 2014. All states and HCBS settings must comply by March 2019. To date, only Tennessee's plan has been finalized.

Confusion surrounding the rule could limit the ability of assisted living and memory care providers to serve Medicaid beneficiaries, leaders of the Senate Special Committee on Aging told CMS in a September letter. (Pictured above: Sens. Claire McCaskill and Susan Collins lead a Sept. 7 Senate Special Committee on Aging hearing.) That letter was followed up with one from NCAL leaders in October. In December, CMS issued related guidance about HCBS for those with dementia.

Also as the year ends, a court injunction putting a new overtime rule on hold has many senior living operators at a crossroads, wondering whether it would be better to put planned changes in place for affected employees or keep things as they are until the matter is resolved. The rule, opposed by several senior living groups but finalized in May, calls for doubling the salary threshold under which most salaried workers would be guaranteed overtime pay when they work more than 40 hours per week. It originally was set to take effective Dec. 1.

Also on hold, at least for now, is a new federal rule that would have disallowed pre-dispute arbitration agreements during nursing home resident admissions. A federal court granted the American Health Care Association's motion to stop the ban from beginning in late November. The rule originally was set to go into effect Nov. 28. Representatives of AHCA's sister organization, NCAL, had encouraged its members to comment on the rule when the CMS was finalizing it in 2015, fearing that a ban at the federal level also might lead to state-level prohibitions in assisted living.

The fate of a final rule requiring employers to publicly report all union-related communication with attorneys is more clear, at least for now, after a federal judge in November issued a permanent injunction preventing the Labor Department from implementing the so-called “persuader” rule. The Labor Department could appeal the ruling, however, and the rule faces several other pending court challenges, too.

Among other regulatory actions in 2016, the Occupational Safety and Health Administration updated its Recommended Practices for Safety and Health Programs guidelines, the Labor Department announced increased maximum penalties for OSHA workplace safety violations, OSHA issued a final rule requiring residential care facilities and community care facilities for the elderly to electronically submit their workplace injury and illness data, and the Equal Employment Opportunity Commission announced that it will begin collecting summary employee pay data from some employers in March 2018.

It was our January article about a proposed Environmental Protection Agency rule regarding the disposal of unused medications that garnered the most online readers in 2016, however. Leaders of several organizations representing assisted living providers worried that the government's apparent lack of understanding of the difference between assisted living communities and skilled nursing facilities could put some assisted living providers “perpetually in noncompliance.” That rule has not been finalized.

In the fall, the uncertainty of what a Donald Trump presidency means for seniors housing and care loomed large in the minds of industry leaders. Among topics pondered was how the new administration will affect value-based care efforts.

The American Seniors Housing Association said that Trump's background in real estate development, operations and business in general should benefit the seniors housing industry, but the National Low Income Housing Coalition said that the new administration could bring billions of dollars in cuts to affordable housing and other anti-poverty programs. Yet the NLIHC identified six areas where affordable housing advocates and conservatives might find common ground.

LeadingAge and AHCA/NCAL pledged to work to keep aging issues top-of-mind for lawmakers, whereas Argentum said it remains focused on government at the state level.

3. Fraud

Alleged fraud involving senior living executives or residents made headlines in 2016. Some of the bigger cases are noted here.

In February, Jon Michael Harder, the former CEO of Sunwest Management who pleaded guilty to mail fraud and money laundering, began a 15-year sentence at a federal prison. He had pleaded guilty in January 2015 to one felony count of mail fraud and one felony count of money laundering and admitted to lying to more than 50 assisted living community investors to obtain more than $5 million from late 2007 through February 2008.

Legal issues for former Assisted Living Concepts CEO Laurie Bebo continued in 2016 when, in March, the U.S. Supreme Court effectively said that she cannot challenge in federal court the constitutionality of the U.S. Security and Exchange Commission's use of an administrative law judge instead of a federal judge and jury while a proceeding against her is underway.

Bebo's filing stemmed from a legal case that began in 2014 when the SEC filed fraud charges against her and ALC's then-chief financial officer, John Buono. The commission alleged that the two directed employees to include phony residents in occupancy rate and coverage ratio calculations for eight properties from 2009 to 2012. Buono settled his case with the SEC in 2015, but Bebo filed a lawsuit against the commission, maintaining that its internal proceedings, using an administrative law judge instead of a federal judge and jury, would deprive her of her rights to equal protection and due process.

In July, the federal government announced that Philip Esformes, the owner of more than 30 Miami-area assisted living and skilled nursing facilities, had been charged with conspiracy, obstruction, money laundering and healthcare fraud in connection with a $1 billion scheme that it called “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice.” A motion filed by the government alleged that Esformes provided access to assisted living residents “for any healthcare provider willing to pay a kickback,” including pharmacies, home health agencies, physician groups, therapy companies, partial hospitalization programs, laboratories and diagnostic companies. His trial is set for Sept. 18, 2017. (Pictured above: Esformes' alleged $1 billion healthcare fraud scheme.)

In September, a subsidiary of Oklahoma-based BOK Financial Corp. agreed to pay more than $1.6 million to settle charges that it concealed information from investors in municipal bond offerings to purchase and renovate senior living facilities, according to the U.S. Securities and Exchange Commission. The case is tied to that of Atlanta-based businessman Christopher F. Brogdon, who was charged with fraud in November 2015 and was ordered to repay $85 million to investors after reportedly misusing investor funds raised to buy and refurbish senior living facilities.

In October, the former CEO of American Senior Communities and three others were indicted for their alleged roles in a $16 million fraud, kickback and money-laundering scheme. CEO James Burkart's home originally had been raided by the FBI in September 2015, and ASC subsequently fired him and Chief Operating Officer Dan Benson, also named in the indictment. A defendant in the case agreed to plead guilty in December, putting him in the position of possibly testifying against others accused in the case.

Also in October, the Justice Department and several additional government agencies announced the charging of 56 individuals and five call centers for allegedly scamming more than 15,000 seniors and others in the United States out of hundreds of millions of dollars. Assistant Attorney General Leslie R. Caldwell said the announcement was the “first-ever multi-jurisdiction enforcement action targeting the India call center scam industry.”

In December, a New Jersey woman plead guilty to playing a role in a $1 million Medicare fraud scheme through which residents of affordable seniors housing complexes were convinced to submit to unnecessary genetic testing. She faces up to 15 years in prison and $500,000 in fines.

Earlier in the year, in June, U.S. and Dutch authorities simultaneously took action against a man and two companies accused of defrauding thousands of older adults in the United States of more than $18 million a year through direct mail solicitations. The mass mailings falsely had claimed that the seniors had won, or soon would win, cash or prizes or otherwise would come into a large fortune, the governments alleged.

Illuminating such scams was the purpose of a new guide issued by the Senate Special Committee on Aging in February.

Read more about senior living-related fraud here.

4. Intergenerational programs

Seniors housing and care providers continued to see financial and resident quality-of-life benefits — and perhaps some future staffing benefits — from programs stressing intergenerational relationships in 2016.

A program at Deerfield, a Lifespace Communities continuing care retirement / life plan community in Urbandale, IA, enabled a Drake University vocal performance major to receive board in exchange for performing twice a month for residents. Haley Jenkins enjoyed her experience so much, we later reported, that she decided to stay an additional semester and began contemplating using her musical talents in a career in senior living.

In February, Jim Lay, executive director of Twin Towers, part of Life Enriching Communities in Cincinnati, wrote about about his community's student artists-in-residence program with the University of Cincinnati's College Conservatory of Music, which he said has blossomed into a depth of kinship and connection between unlikely acquaintances. (Pictured above: Alyssa Griffith, left, and Annie Barr, students at the College Conservatory of Music at the University of Cincinnati, are roommates at Twin Towers.)

And senior living communities Butler, PA; Kansas City, KS; and South Bend, IN, were home to professional baseball players during baseball season this year.

In July, a new collaboration between senior living organization Judson Services and the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland was announced. It aims to improve the health of older adults, educate students about the elderly and conduct research to benefit other retirement communities and educational programs focusing on issues related to aging.

And in August, Michigan retirement community Clark on Keller Lake announced that it would be serving as a research setting for the next 19 months as three college students majoring in occupational therapy call it home.

Meanwhile, in Connecticut, Masonicare at A​shlar Village this fall welcomed the first two participants in its new Students in Residence program, believed to be one of the first such programs to focus on assisted living. The participating Quinnipiac University students, one in the pre-med program and one studying occupational therapy, are required to write blogs and spend at least eight hours a week “fully engaged” with their fellow assisted living residents.

In September, Juniper Communities CEO and President Lynne Katzmann and Vice President of Business Development, Sales and Marketing Cindy Longfellow returned from their first Burning Man festival with a conviction that the celebration of individuality, sharing and “open-heartedness” that defines the event is applicable — and necessary — in senior living. Juniper organized the trip, featuring multiple generations although no residents, to “write a new story of aging in America.”

Some senior living/university efforts are set to get underway fully in the future.

Arizona State University, for instance, plans to develop a continuing care retirement / life plan community on its campus, within steps of downtown Tempe restaurants and cultural venues. Construction on the collaboration between the ASU Foundation and Pacific Retirement Services may begin in 2018, according to the university, with occupancy predicted in spring 2020.

And a New York University program, beginning in fall 2017, will see students moving in with seniors in a pilot project designed to make college more affordable for students.

2016 also brought news of plans for what the Los Angeles LGBT Center says is the country's first project that will include affordable housing for both older adults and youth. The $100 million Anita May Rosenstein Campus is scheduled to open in early 2019 in Hollywood.

Read more about intergenerational programs and senior living here.

5. Transportation

2016 seemed to be the year that ride-hailing services came to senior living as a way to address transportation issues for both communities and residents.

It started in August when Canada-based senior living provider Revera, which also has communities in the United States, announced the testing of a new Uber platform in Toronto as a way to improve resident and staff satisfaction. UberCentral, like the Lyft Concierge tool announced later in the year, lets businesses order rides for people who don't necessarily have the smartphones and Uber accounts usually required to order a ride from Uber's independent-contractor drivers. (Accompanying photo courtesy of Uber.)

Later that month, GreatCall and ride-hailing service Lyft announced a pilot program whereby older adults in select markets who use Jitterbug cell phones would be able to arrange for transportation.

In September, Sunshine Retirement Living announced that it had partnered with Lyft to test the ride-hailing service in nine of its communities across three states.

Also in September, Uber and healthcare transportation platform Circulation announced a partnership to test a nonemergency medical transportation service at a Program of All-Inclusive Care for the Elderly as well as acute-care and children's hospitals. Senior living communities may factor into future plans, they said.

In October, Brookdale announced that it was piloting the use of Lyft in one of its communities in California. The operator also is testing the service in Arizona.

In December, Ascension announced that residents of its Ascension Senior Living communities will be among those who will be able to arrange for rides under a new partnership with Lyft.

Also in December, Lyft and CareLinx announced a partnership designed to ease transportation challenges for many seniors.

Interestingly, a JPMorgan Chase Institute study we reported in September suggests that many senior living residents who order a car through Uber or Lyft may find a fellow older adult behind the steering wheel. An increasing number of seniors are supplementing their income “in non-trivial amounts” by participating in the “gig economy,” which includes ride-hailing and other services, according to the research.

Read about other applications of technology in senior living here.

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