Elder Care Issues: A Growing Concern for Employers
(Part 1 of a 4 part series)
During the 1970’s and 1980’s, employers began to recognize the need to offer a more comprehensive package of benefits to their employees. With the unprecedented influx of women into the workforce the challenge of juggling family responsibilities with the demands of the workplace gave rise to a more comprehensive array of “family friendly” benefits.
At that time, one of the most frequent needs expressed by employees was for help finding affordable child day care. What was once offered by only large and cutting edge employers, now has become a commonplace item on the menu of employee benefits.
A growing body of research, ranging from scholarly studies to annual surveys by Business Week and numerous articles in the Wall Street Journal, is calling attention to the aging of the American society and the impact this is having on the huge number of baby boomers that dominate many companies, government agencies and health care settings. Even those industries with a large percentage of younger workers, such as the various high technology industries, are beginning to feel the pinch.
Just as the reality of a global economy is becoming a dominant factor for business, the willingness of employees and their families to re-locate is declining due to growing responsibilities to care for elderly and disabled family members closer to home.
Caregiving responsibilities are proving to be more challenging and stressful than finding child care for working Americans in the new millennium. Caring for aging parents affects millions of baby boomers that are turning 50 at a rapid pace. The combination of increased longevity, and lower birth rates in the 70’s and eighties has resulted in a new phenomenon of family caregiving. The average working couple has more living parents than children. In our mobile society they are more likely to be living far from the aging parent who now needs their help.
According to surveys in 1997, 1999 and 2000 sponsored by such groups as the AARP, Fortis Investors and Metropolitan Life, the cost to US employers in lost productivity and other costs may exceed $29 billion. More than half of Americans have friends or relatives who have needed long-term care, and nearly 30 percent have provided hands-on or personal care assistance, according to a survey of 1,000 adults by the National Council on the Aging (NCOA).
Caregiving takes a heavy toll on work and family life. Among those who have provided hands-on care, 67 percent reported that it has had a significant impact on their family lives, and 41 percent reported that it had a significant impact on their work. More than 10 percent of those who have provided long-term care assistance said they had given up promotions or jobs as a result. (This story will continue next month)
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America’s Worst Nursing Homes: Will The “Crisis” Improve? Don’t Count On It!
As a resident of Massachusetts, it was discouraging to learn recently that I live and work in a state that has become among the worst places in America to receive nursing home care.
In an exhaustive, comprehensive study of onsite inspection and complaint data on nursing homes, published in February, Health Grades, Inc. has identified the best and worst cities for nursing home care. HealthGrades, the nation’s leading private authority on reporting the quality of healthcare facilities in the U.S., released its latest national nursing home ratings on its Web site.
If you have a strong stomach you can read all the grim details at http://www.healthgrades.com/. I must warn you, however, that the research highlighted by Health Grades lists the 22 “Worst Cities in the U.S.” for nursing home quality. Boston and Worcester, my state’s two largest cities, are both on the list.
The evidence of the severity of the nursing home crisis in this country is overwhelming and incontrovertible. The same week that Health Grades identified our state capital and the “Heart of the Commonwealth” as two of the worst places in the country to be in a nursing home, the Department of Health and Human Services released a report revealing that we are just the bottom of a very large barrel of rotten apples. DHHS reports, “ more than 91 percent of the nation's nursing homes are inadequately staffed. “
Are you surprised that the quality of nursing home care, at a time when the fastest growing age group in America is those over age 85, has deteriorated to such a sorry state? Well, I hate to tell you this, but it’s not exactly “news”.
Nearly a year ago, April 18, 2001 to be exact, a Boston Globe editorial declared a “Nursing Home Emergency” in Massachusetts.
The editorial illustrated how serious this situation has become. ” Nursing homes are closing their doors almost as frequently as dot-com companies...56 closures since 1999 with another 50 nursing homes expected to close by late next year”.
The editorial correctly points out that this “emergency”, is due to the fact that state-set Medicaid reimbursement rates have not kept pace with costs, especially the cost of labor, and urges the legislature to take the lead in increasing total reimbursements, with an eye particularly toward raising the pay of workers.
On February 26 of this year, the Boston Globe published an Op Ed column written by Joan Fitzgerald, associate director of the Center for Urban and Regional Policy at Northeastern University.
Fitzgerald points out that insufficient government reimbursement is a key cause of the understaffing crisis. “The average starting wage for nurse aides in nursing homes is $6.70 per hour, yielding an annual income of $14,000 for full-time workers, mostly without benefits.
Nationally, the average wage for nurse aides in nursing homes is $7.93, suggesting there is little opportunity for advancement.” “ Low wages, says Fitzgerald “are a big part of the reason more than 40 states have critical shortages of nurse aides.”
“High turnover imposes costs. Replacing a nurse aide costs almost $4,000 in advertising, orientation of new workers, lower productivity of new workers, and temporary labor. An intangible cost of turnover is the deterioration of care due to new caregivers not knowing patients' special needs.”
She further points out “Understaffing means that those who do stay on the job are overworked. Studies by the National Network of Career Nursing Assistants show that nursing assistants cannot perform their five main responsibilities - bathing, feeding, eliminating, ambulating, dressing - for 20 patients in an eight-hour shift, a typical workload.”
While the deteriorating conditions in our nursing homes are indeed appalling, was the Boston Globe correct in calling this an “emergency” last year? My Merriam-Webster dictionary defines emergency as “an unforeseen combination of circumstances or the resulting state that calls for immediate action”.
In May of 1999, nearly a year before the Globe’s calling it an “emergency”, the federal official responsible for overseeing nursing home standards openly admitted that inadequate state and federal funds would force the closing of many facilities. Her admission was outlined in a letter to state officials on May 9, 1999. Sally Richardson, then Director of the Health Care Financing Administration's (HCFA) Center for Medicaid and State Operations, (The federal agency that oversees the funding of Medicaid dependent nursing homes) warned the fifty state Medicaid directors that several nursing home chains were reporting significant financial difficulties and may close or at least withdraw from the Medicare and Medicaid programs.
“For these reasons,” Ms Richardson said, “ we are asking that you pay particularly close attention to these situations should they develop. In particular, we want to be sure that resident health and safety are protected despite the financial decline of any nursing home or hospital organization.”
Did this Clinton administration official call for more funding to alleviate this “emergency”? No. Her letter, instead urged the following actions: “... (State Medicaid officials should)… develop contingency plans to handle closures of multiple nursing homes... should they occur. A process to identify the availability of beds or alternative resources that can be drawn upon should the relocation of residents become necessary. Consideration of the use of revenues from collected civil money penalties to help underwrite transition costs of relocating residents, and a review of state receivership laws to better prepare for new facility management should it become necessary to invoke these authorities.”
So if the latest revelations about how truly abominable nursing home care has become in Massachusetts and elsewhere are disturbing, they can hardly be said to have been “unforeseen”.
If you think that the most recent revelations are likely to get public officials to respond with “Immediate action” don’t hold your breath. Not only have both federal and state officials responsible for these conditions known it was coming for years, recent statements by President Bush indicate that nursing home care will get a whole lot worse before it gets better.
According to Northeastern’s Joan Fitzgerald “Rather than establishing minimum staffing levels, which President Bush claimed would be too costly, the administration plans on letting market forces resolve the shortage.
Fitzgerald points out that “The fallacy of the market solution is that pay rates for direct care workers in nursing homes are essentially set by government reimbursements, not by labor supply and demand. The government pays about 60 percent of direct care worker wages through Medicaid and Medicare.”
In other words no matter how horrifying current nursing home conditions may be to each of us as individuals, nothing will be done about it until we recognize that the “problem”, “emergency”, “crisis” or whatever other term we want to use will continue to get worse as long as we taxpayers refuse to accept the additional cost required to bring nursing home care up to minimal standards of safety and decency. Care will continue to worsen as long as we voters sit back and let politicians in both parties pander to older voters with promise to “improve the lives of the elderly” while allowing these deplorable conditions to continue .
But wait a minute. I shouldn’t be so hard on the politicians. After all we happily cashed the checks that the President sent us from that big federal “surplus” he keeps insisting we have. It’s not the Pols fault after all. They’re just doing what we asked them to do.
An Alternative to Help People Remain in Their Homes: Rhode Island Start Up Company Will Offer Services to Adults With Disabilities
Jeff Mason has a mission. He’s dedicated to helping people with disabilities remain in their homes for as long as possible, in a cost effective living alternative. His new company, Healing Homes, offers what Jeff calls “the next generation of solutions in meeting the needs of this population."
The business model for Healing Homes is driven, in part, by the aging "baby boomer" demographic that will, as you are all aware, add dramatically to our elderly population in the very near future. Additionally, accident victims with brain and spinal cord injuries, children with congenital birth defects, Alzheimer's sufferers and other people with serious disabilities are also in crisis. Healing Homes intends to become a comprehensive, “double-bottom line, healthcare company” says Mason. One that delivers easy to use total wellness solutions to housing and medical/telemedical problems as well as web-based socialization opportunities.
Under development since 1996, Healing Homes has targeted a network of strategic alliances to insure acceptance of its products and problem-free distribution. Collaboration with groups like AARP, HUD, VA, the American Congress of Healthcare Executives and the Easter Seals Society will maximize the quality and coordinate timely introduction into the marketplace. JCAHO certification will assure accreditation to the highest healthcare industry standards. Mason recently completed a study for the Joint Center for Housing Studies at Harvard University entitled “Housing that Supports Successful Aging” (draft available upon request). Healing Homes will use referrals and endorsements from the network of existing strategic alliances to quickly grow market share within a consumer group that often feels overwhelmed by a lack of control over their own circumstances and suffers sticker shock when exploring traditional forms of care for their disabled loved one.
The market, including seniors, children and younger adults who join the disabled every year, will increase by more than one million annually over the next decade. It is estimated that care providers will grow from 21 million in 2000 to 50 million by the year 2010. Distribution goals include the Eastern and Southern United States as well as Eastern Canada in that same time frame. Although conceived as a private payer solution, it is believed that the private healthcare insurance industry and the government-funded Medicare/Medicaid systems will recognize significant cost savings to them and actively fund all or most of the “suite’s” cost for disabled consumers in the year’s ahead.
Mason describes Healing Homes first generation product as factory built; “universally accessible”, master bedroom suites with full access bathrooms that are built to the BOCA building code (modular units). The typical American home (71.4 million Americans are homeowners today) is built to house fully functioning family members only. Most single-family homes have bedrooms and full bathrooms on the second floor and require that the occupants climb a flight of stairs to gain access to these basic amenities. So, my architecturally designed, universally accessible, housing suites solve their most immediate problem of maintaining access to their home, to these basic amenities and to their loved ones. HealingHomes guarantees a person with a disability greater independence and the opportunity to age near their family, as well as maintaining their freedom and their all-important sense of place.
HealingHomes second generation of products and services will offer suites for lease by the month. Additionally, HealingHomes will introduce a fully “handicap accessible”; “hospital room on wheels” that, with a fully self-contained support system, can be set up and leased “just in time “ for the patient’s primary care discharge and can be comfortably occupied for three to six weeks while the BOCA suite’s installation is completed. Also planned is the incorporation of telemedical units that will allow the monitoring of the HealingHomes patient’s vital signs 24 hours per day with wireless transmission of their bio-metric data to a hospital or a doctor’s office via the Internet.
Employing video cams at both ends will allow a doctor, VNA nurse, etc. to make “virtual” house calls, loved ones can check up on the disabled person from remote locations like their office and fellow HealingHomes™ consumers can have interactive conversations, with a fellow home bound resident, as well. The Disney-built community known as “Celebration” in Florida has wired each home to the Celebration community hospital and is designed with this type of electronic support network in mind.
HealingHomes™ has been designed with reference to the work of leading primary healthcare facility architects who have identified and included healing elements in their designs; i.e., indirect lighting, abundant sunlight, tranquil colors, soothing sounds, control of utilities from the person’s bed, etc. HealingHomes™ BOCA suites can both be owned and permanently attached to an existing dwelling or leased and temporarily set on a foundation with a connecting ramp built to the main residence for easy access. It can be sited at the home of the person with the disability, if a spouse is present or, for instances, at the home of an adult child of the disabled person. The goal of the design work has been to maximize independence for the healthcare consumer and give them as much CONTROL over their environment as possible; to eliminate “dis-ease” and optimize both their physical and mental health. We “environmentally optimize the healing response” to promote the well being of the whole person.
Jeff Mason can be reached at healinghomes@hotmail.com. |
