Here’s a look at some of the news that occupied many minds in senior living over the past year.
Year of the woman?
2019 seemed to be the year of the woman leader in senior living:
- Katherine “Katie” Potter was announced in December 2018 as the incoming new president and CEO at Five Star Senior Living, , Newton, MA, the nation’s fourth-largest operator of senior living communities, and began in that role in January 2019.
- Kimberly S. Lody was appointed president and CEO of Dallas-based Capital Senior Living Corp. in January, effective immediately. The company is in the top 10 of largest senior living operators.
- Shelley Kendrick was announced in January as president and CEO of Ecumen, Shoreview, MN, one of the country’s largest nonprofit senior housing and services providers. She assumed the role in February.
- Graceworks Lutheran Services’ first woman CEO, Judy Budi, was announced in January and began serving in the position at the Centerville, OH-based organization in March.
And all of those announcements occurred before the first month of the year was over!
The news kept coming throughout the year. In October, Helen Crunk of Nebraska was elected chair of the National Center for Assisted Living Board of Directors, and Debbie Meade of Georgia was elected chair of the American Health Care Association Board of Governors, both for 2019-2020 terms. Their elections marked the first time ever that the boards are simultaneously led by women, AHCA / NCAL told McKnight’s Senior Living.
In November, Tana Gall was named president of Merrill Gardens, Seattle, starting in December, as Merrill Gardens announced that it had acquired Portland, OR-based Blue Harbor Senior Living, a senior living management company where Gall had been the CEO for the past three years.
For McKnight’s Senior Living and sister brand McKnight’s Long-Term Care News, the year held special memories, as the first McKnight’s Women of Distinction Awards were bestowed on 41 deserving women May 16 in Chicago. (McKnight’s plans to honor additional deserving women in 2020. See this page for more information. The nomination deadline of Jan. 8.)
Verdict comes in ‘largest single criminal healthcare fraud case’
April brought a guilty verdict for Philip Esformes, the owner of multiple Miami-area assisted living and skilled nursing facilities accused in 2016 of orchestrating a $1 billion healthcare fraud scheme that the Justice Department says is “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice.”
Esformes was found guilty on more than 20 charges, including bribery and paying kickbacks. He was sentenced to 20 years in prison in September and subsequently was ordered to pay $44.2 million in restitution and forfeit property. He is appealing.
Solving the middle market puzzle
The eagerly awaited National Investment Center for Seniors Housing & Care-funded study on the impending potential middle-market senior housing crisis was published in April by Health Affairs.
Researchers predicted that 54% of the 14.4 million middle-income older adults in 2029 in the United States will lack the financial resources to pay for senior housing and care, and a combination of public and private efforts will be needed to address the looming issue. Additional number-crunching revealed that 2.3 million older Americans would be able to afford senior living if the annual cost were reduced by $10,000, and 3.6 million more would be able to afford it if the cost were reduced an additional $5,000.
The study has brought the topic to the forefront of the minds and lips of those in and serving the senior living industry. Health Affairs held panel discussions related to release of the study, and NIC held an Investor Summit. A two-year effort led by LeadingAge Virginia will culminate this spring in the release of a “playbook” designed to help senior living and care providers determine whether and how to serve middle-income older adults. The topic also was a focus of NIC’s Fall Conference, a fall CliftonLarsonAllen report and corporations’ press releases.
No doubt interest will continue in 2020 and beyond.
Operators joining or forming Medicare Advantage plans
2019 also brought big news on the Medicare Advantage plan front.
In late September, Toledo, OH-based real estate investment trust Welltower announced that it planned to collaborate with CareMore Health to try to improve care and outcomes while reducing the total cost of care for residents of some of the senior living communities in the REIT’s portfolio. Specifically, Welltower said, CareMore’s clinical programs and onsite care models will be integrated at Belmont Village and SRG Senior Living independent and assisted living communities in Los Angeles and Orange County, CA.
The arrangement will introduce residents in the communities to Medicare Advantage institutional special needs plans (I-SNPs), offered through CareMore’s partnering health plans, through which CareMore clinicians will deliver and manage care. Welltower also said it plans to expand its collaboration with CareMore to other regional and national markets in the future.
At the beginning of October, 10 senior living and care organizations in the Minneapolis / St. Paul area announced that they would offer a new HMO I-SNP to their residents effective Jan. 1 in what plan collaborators believe is one of the largest rollouts of an I-SNP in the country and could lead to a national model of care.
Medica Advantage Solution PartnerCare, a Medicare Advantage plan offered through a collaboration with geriatric medical practice and care management organization Genevive, nonprofit health plan Medica and the long-term care companies, would be available exclusively to the approximately 5,500 qualifying assisted living, memory care and skilled nursing residents living in 78 communities, they said.
Later in October, Richmond, VA-based Medicare Advantage plan developer and administrator AllyAlign Health and Bloomfield, NJ-based Juniper Communities announced that Juniper’s Connect4Life care coordination model soon would be finding its way into senior living communities across the country under the terms of a new five-year licensing agreement between the two organizations.
The partnership with Juniper gives AllyAlign exclusive rights to implement Connect4Life as the foundation for its Centers for Medicare & Medicaid Services-approved care model as part of the company’s Medicare Advantage plans nationwide. Juniper will retain the right to continue using Connect4Life in its communities and future partner locations.
Separately, Juniper and AllyAlign already were working together on the Perennial Consortium, an operator-owned Medicare Advantage network that includes additional founding members Christian Living Communities, based in Englewood, CO, and Ohio Living, based on Columbus, as well as other partners. Perennial is using the Connect4Life care model as a foundation for its plans, for which enrollment will begin in late 2020, with coverage effective Jan. 1, 2021.
Regulation in assisted living
For the second year in a row, more than half of the states changed their assisted living requirements in 2019, indicating a potential trend that the National Center for Assisted Living said it expects to continue.
Minnesota passed a landmark elder care law, elements of which went into effect Aug. 1. The state’s assisted living licensure system, the last in the country, will become effective in August 2021.
The Gopher State and North Dakota joined at least two other states that previously had approved legislation that allows residents or their representatives to conduct electronic monitoring in assisted living resident rooms. In December, two Ohio lawmakers announced that they were considering a similar move to allow cameras.
In Georgia in October, the governor and other elected officials discussed regulatory changes that would affect assisted living providers in the state after an Atlanta Journal-Constitution series of articles reported that there were more than 600 allegations of neglect and 90 of abuse by caregivers in the past four years.
On the federal level, the Labor Department proposed a four-factor “joint employer” test and issued a final rule related to overtime pay affecting all employers, and CMS issued new guidance meant to clarify where Medicaid beneficiaries can receive home- and community-based services.
In April, the Government Accountability Office urged CMS to address a recommendation made in its January 2018 report on assisted living and said it would be monitoring CMS to see what actions it takes. In August, the Health and Human Services Office of Inspector General said that assisted living providers that serve Medicaid beneficiaries would be the focus of a report released in fiscal year 2020.
In September, North Dakota became the final state to have a Medicaid Fraud Control Unit. The entities investigate and prosecute Medicaid provider fraud and resident / patient abuse and neglect in assisted living communities, skilled nursing facilities and other healthcare facilities.
In November, presidential hopeful Pete Buttigieg released a plan for long-term care; in part it calls for establishing federal standards for assisted living communities, including staffing ratios, required access to mental health clinicians and annual inspections.
Technology: Digital assistants, telehealth, data breaches
Technology news continued to make waves in senior living in 2019. Not always good ones.
In June, for instance, ResiDex Software, a company that provides software for assisted living communities, group homes and other organizations serving elderly or disabled individuals announced a potential data breach that affected almost 60 facilities or companies in Massachusetts, Minnesota, Missouri and Tennessee. The next month, ResiDex said that additional senior living operators, staff members and residents potentially were affected by the breach.
And in September, a Wyoming health system that includes a long-term care facility reported a ransomware attack that affected all 1,500 computers, disrupted service provision and forced the use of paper charts instead of electronic health records.
Individually, senior living residents and other older adults continued to be affected by scams, many of them involving technology such as computers and telephones. Older adults lost $649 million in internet scams, according to a report issued in April by the FBI’s Internet Crime Complaint Center.
Meanwhile, telehealth has been touted for its potential to improve employee satisfaction for workers who have access to it and reduce emergency department visits for some senior living residents. However, a National Poll on Healthy Aging survey about telehealth conducted by the University of Michigan Institute for Healthcare Policy and Innovation, conducted in May and released in October, found that more than 80% of the adults aged 50 to 80 polled expressed at least one concern about seeing a physician or other healthcare professional virtually rather than in person.
Additional research provided insights into consumer views of telehealth. In November, Costa Mesa, CA-based J.D. Power issued its first-ever U.S. Telehealth Satisfaction Study. Fielded in August and September, the study found that consumer use of telehealth remains low, but for those who have used it, satisfaction with the experience ranks among the highest of any consumer category studied by the insights and data company.
But the technology story of most interest to McKnight’s Senior Living readers came earlier in the year, in April, when Amazon announced that Alexa, the virtual assistant increasingly found in senior living communities across the country, now was capable of transmitting and receiving protected health information. The company had been working with six organizations — including two parent organizations of senior living and supportive housing providers — as part of an invitation-only program to test the capability.
The new HIPAA-compliant status means that operators and residents alike may find more reasons to use the device. In fact, in November, Amazon announced that a new Alexa feature enables people to review prescriptions and set medication reminders by using their pharmacy prescription information, as well as request prescription refills by voice command. The new feature, launched in partnership with Omnicell, is available to customers of the pharmacies inside the 229 grocery stores operated in Indiana, Maryland, Ohio, Pennsylvania and West Virginia by Pittsburgh-based Giant Eagle. More pharmacy providers will be added to the program in 2020, however, Amazon said.
Brookdale Senior Living’s board battle with Land & Buildings
Things got especially heated between Brentwood, TN-based Brookdale Senior Living and an activist shareholder in 2019.
In August, the country’s largest senior living company announced that its Board of Directors unanimously had proposed two nominees, Vicki Freed and Guy Sansone, to succeed two board members who were stepping down. In making the decision, board members passed over two candidates suggested by Stamford, CT-based Land & Buildings, a Brookdale shareholder that has characterized the company as underperforming financially and has publicly called on the company to take certain steps to maximize shareholder value.
Land & Buildings’ two candidates were Jonathan Litt, the registered investment manager’s founder and chief investment officer, and James Flaherty, managing partner of investment firm Corby 2.0 and the former CEO of REITs NorthStar Healthcare Income and HCP.
Land & Buildings subsequently filed with the Securities and Exchange Commission a preliminary proxy statement asking fellow Brookdale shareholders to elect the two candidates it supported, but Litt later withdrew his name from consideration, throwing support behind Brookdale candidate Sansone but not Freed.
Both Brookdale and Land & Buildings made their cases for their candidates in subsequent letters and SEC filings, and Land & Buildings filed a definitive proxy statement for shareholders to consider. In October, Litt withdrew Flaherty’s name from consideration, too, however, although he promised to continue to watch Brookdale’s progress on its “path towards shareholder value creation.”
Challenges, support for LGBT older adults
Early 2019 saw a federal judge’s dismissal of a lawsuit against a Missouri continuing care retirement community that had been accused of discriminating against a lesbian couple by not allowing them to live there.
Another challenge for lesbian, gay, bisexual and transgender older adults came in May, when the Department of Health and Human Services Office for Civil Rights issued a final rule stating that individual healthcare workers as well as healthcare organizations could decline to provide care that conflicts with their religious and moral beliefs or mission.
The final “conscience rule” made several references to abortion but also referred to advance directives, “assisted suicide, euthanasia, or mercy killing,” “compulsory healthcare or services generally, and under specific programs for hearing screening, occupational illness testing; vaccination and mental health treatment” as well as “certain requirements under Medicare and Medicaid that may burden their exercise of their religious beliefs regarding medical treatment.” Elder advocacy group SAGE also noted that some feared that the rule could make it easier to discriminate against LGBTQ individuals.
In November, three federal judges, issuing decisions in lawsuits, tossed the rule.
The year contained some additional good news for the LGBT community, with the April announcement by SAGE and the Human Rights Campaign Foundation of plans for what they believed was the first-ever nationwide tool to assess how well senior living and other long-term care facilities are treating LGBTQ residents. By December, 47 national, statewide, regional and local aging, senior services or LGBTQ membership or advocacy organizations had endorsed the voluntary Long-Term Care Equality Index, or LEI, and were encouraging residential long-term care facilities to take the related Commitment to Caring Pledge.
Getting serious about the flu
Additional senior living operators got serious about flu vaccination among workers in 2019.
In May, Hickory, NC-based Affinity Living Group announced that it was mandating flu vaccination for its more than 4,000 employees beginning with the 2019-2020 flu season. The company later went on to dominate the list of assisted living communities and skilled nursing facilities on the Influenza Vaccination Honor Roll of the Immunization Action Coalition, a branch of the Centers for Disease Control and Prevention, accounting for 100 of the 130 long-term care facilities on the list as of July 30.
Louisville, KY-based Signature HealthCARE announced its new flu vaccination policy for the 2019-2020 flu season in August, saying it would apply to all employees, residents, patients, volunteers, vendors and others in any of the organization’s assisted living, memory care, skilled nursing and rehabilitation facilities. The organization has more than 17,000 employees, including home health employees, across 10 states, and more than 100 locations.
Older adults are among those vulnerable to negative health effects from the flu. Experts convened by the Gerontological Society of America’s National Adult Vaccination Program recommend that assisted living organizations and other long-term care employers mandate flu vaccination for staff members and make vaccination a condition of employment for workers. Vaccination among healthcare workers is highest when their employers require or promote it, according to the government.
Affiliations, partnerships continue
The long-term care subsector had the most merger and acquisition deals among all healthcare subsectors in the second quarter of 2019, continuing a trend that has been observed since at least 2014, according to a report from PwC.
2019 started out with the completion of the affiliation between Sioux Falls, SD-based Evangelical Lutheran Good Samaritan Society and Sanford Health. It continued with the announcement of a partnership between WesleyLife and Genesis Health System, in a new entity called WellSpire, to develop senior living communities to serve eastern Iowa and western Illinois.
United Methodist Retirement Communities and Porter Hills Presbyterian Village finalized their $150 million affiliation in March, creating the third-largest nonprofit senior living organization in Michigan.
The second quarter, in April, found West Point, PA-based Acts Retirement-Life Communities and Eldersburg, MD-based Integrace completing their affiliation, bringing the two not-for-profit organizations together under shared governance and leadership.
In June, West Des Moines, IA-based Lifespace Communities and Addison, TX-based Senior Quality Lifestyles Corp. closed on an affiliation announced the previous month. Lifespace now is the sole owner and operator of three former SQLC communities — Edgemere in Dallas, The Stayton at Museum Way in Fort Worth, TX, and Querencia at Barton Creek in Austin, TX — and SQLC’s management company, Seniority.
Some of the other affiliations announced in the second quarter and beyond in 2019 include:
- June — HumanGood and Presby’s Inspired Life, based in Pleasanton, CA, and Lafayette Hill, PA, respectively, announced plans to create a unified company and expand into the middle market.
- July — McCready Health of Crisfield, MD, and Peninsula Regional Health System, based in Salisbury, MD, reached a definitive agreement to merge. As part of the deal, officials said, McCready Health’s Chesapeake Cove Assisted Living and Tawes Nursing Home also would become part of PRHS.
- July — Divine Savior Healthcare and Aspirus signed a letter of intent to affiliate, with a deal that was expected to be finalized by the end of the year. The affiliation would affect the Wisconsin-based systems’ assisted living, memory care and skilled nursing offerings.
- July — The communities, programs and properties of Williamsville, NY-based Presbyterian Senior Care of Western New York will become part of Getzville, NY-based Beechwood Continuing Care under an agreement reached by the two not-for-profit organizations.
While some organizations underwent structural changes, the year brought new identities to other senior living entities.
In February, San Francisco-based nonprofit Northern California Presbyterian Homes and Services changed its name to Sequoia Living, and Ellicott City, MD-based Lorien Health Services unveiled a new logo and tagline.
In October, Dallas-based Presbyterian Communities and Services announced its new name, Forefront Living.
Also, Evanston, IL-based Mather LifeWays announced a name change to Mather and unveiled a new logo and tagline as part of a rebranding initiative.
And Irvine, CA-based real estate investment trust HCP Inc. announced a new name and ticker symbol. The REIT’s new name is Healthpeak Properties, and the company’s common stock now trades under the new name and ticker symbol PEAK on the New York Stock Exchange.
Community, individual certifications
Certification-related news hit at the beginning and end of the year.
The first three senior living communities to earn J.D. Power’s Senior Living Community Certification were announced in February. All were Five Star Senior Living communities.
The communities earned the honor by passing an evaluation covering approximately 174 operational best practices relating to community mission, culture and structure; licensing and safety; community staff; resident relations; resident services; sales, marketing and move-in coordination; and other factors. Communities also passed a one-day, on-site audit to be certified.
Additional senior living communities have earned the honor since February.
In December, the American College of Health Care Administrators announced that it was discontinuing the exams for the certified assisted living administrator (CALA) and certified nursing home administrator (CNHA) credentials. Professionals currently holding the credentials will be able to renew them every five years through the organization’s “executive portfolio” or its executive-level courses.
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