As the “silver tsunami” approaches, numerous industries are preparing for the waves of baby boomers who are reaching retirement age, but perhaps none more than those in the senior living arena.
“When I got here eight years ago I think we had one and a half staff members in our clinical education team. Today that team is a staff of nine,” says Michael McRae, president and CEO of St. Ann’s Community, indicative of one way the organization has prepared for the onslaught of the elderly seeking to live in one of its communities. “We intentionally went out after a director of staff education that not only had acute care experience, but also had academia experience—the ability to teach adult learners.
“She’s built this team so that when an admission is coming in and it’s a diagnosis or treatment plan that we don’t see every day, she’s able to do real-time, just-in-time training for the staff,” he adds.
Nearly 186,000 individuals in the Rochester metro area are 65 and older, which represents more than 17 percent of the region’s population. Some 125,000 of those individuals reside in Monroe County, the U.S. Census Bureau reports. Statewide, nearly 3.2 million people are 65 or older.
Estimates from the state Office for the Aging suggest those numbers will continue to increase over the next two decades as baby boomers and subsequent generations age. By 2020, the state’s population over 65 is expected to be roughly 3.66 million; by 2040, experts predict that age group will rise to 4.4 million statewide.
Likewise, Monroe County’s 65 and older population is projected to increase from roughly 133,795 in 2020 to 172,839 in 2040. As well, the disabled population over 65 is expected to rise from roughly 42,000 in 2020 to nearly 55,000 in 2040.
That has far-reaching consequences for the senior living industry, particularly as it pertains to clinical care.
“The good news is people are able to stay where they want to stay longer. That’s where we’ve moved as a society and that’s all good,” McRae says. “What we do find is that when they come to a nursing home they’re coming much later in life, much more frail and with many more co-morbidities.”
Amanda Teugeman, vice president of healthcare services at Episcopal SeniorLife Communities, says she has witnessed the same phenomenon.
“The residents over the last decade that have been admitted to the Church Home are a lot more clinically complex than they were before, meaning they’re coming in with a lot more co-morbidities, or diagnoses,” Teugeman says. “Before it was just one or two things; now they’re coming in with a lot more medical needs that our teams have to address.”
Adds Sue Webb, executive director of Episcopal SeniorLife’s assisted living community, Brentland Woods: “People are waiting longer to move in, so we’re getting people who are older, and they’re more medically fragile; a lot of medications and more hands-on care that’s needed.”
Additionally, says Paul Bartlett, vice president of senior housing for St. John’s Senior Services Inc., in the past, residents would need to leave their homes to receive medical or clinical care.
“What we’ve found is it’s far more convenient for them and less disruptive to their lives if we bring those services here,” Bartlett said.
To that end, area senior living facilities are addressing those needs and have upped the types of clinical services they offer. At St. John’s, which offers nursing home care, enhanced assisted living, rehabilitation and senior independent living, residents in enhanced living are able to receive clinical care 24 hours per day, seven days per week from licensed practical nurses and care partners, Bartlett noted.
Enhanced assisted living, such as what is offered at the Hawthorne, operated by St. John’s, is a special licensure the state Department of Health gives that allows the facility to provide clinical care.
“What they can do now is they can provide care for residents that may need catheter management or diabetes injections, whereas in a normal assisted living scenario they can’t do a lot of hands-on care,” he explained.
Scott Schabel M.D., who serves as medical director at the Friendly Home, says the most striking change he’s seen during his 25 years of taking care of elderly people in Rochester, is the change in dental care.
“When I started caring for elderly patients the majority of them had dentures. But guess what? They sold a lot of Crest toothpaste in the 1950s and today everybody has teeth,” Schabel says, only half in jest. “That’s a remarkable example of how our evolution of all kinds of health care has dramatically changed peoples’ lives.”
In addition, men are beginning to live longer, Schabel says, which changes the dynamic at nursing homes.
“Twenty-five years ago 95 percent of my nursing home patients were female, but with the advent of aspirin for heart disease and cardiologists that have all their fancy catheters, they’re able to keep men living much longer than they did just a short couple of decades ago,” Schabel says. “So we now have a much more thriving male population in our various senior living settings.”
And that could mean different clinical care mechanisms, depending on those male residents’ needs.
“We have had a lot of advances in the treatment of heart disease, diabetes, cancers so that what may have been a death sentence a couple decades ago people are now living with,” Schabel says. “While that may create a bit of a health care burden, they’re still with us and still enjoying life to some extent.”
Types of clinical services available in senior living depend on the type of facility, Teugeman and Webb say. For example, at Episcopal Church Home, 100 percent of a resident’s care can be handled.
“We also have a full rehab unit where we provide wound care, respiratory care; we do medication administration, we do IV antibiotics, IV fluids that a lot of places don’t do and we do have acute rehab,” Teugeman says. “The only thing we don’t do at the Church Home is tracheotomy care.”
In skilled nursing, Episcopal SeniorLife has medical coverage around the clock, she adds, and Monday through Friday a doctor or two is available, as well as nurse practitioners.
“So at the skilled level, anything that a doctor could do at the hospital could be done here as far as diagnosing and treating,” Teugeman says.
As an assisted living facility, Brentland Woods is unable to provide clinical care for its residents. In New York State, assisted living facilities provide long-term, non-medical residential services to adults who are unable to live independently due to physical, mental or other limitations associated with age or other factors. Residents must not require the continual medical or nursing services provided in acute care hospitals or skilled nursing homes, as assisted living facilities are not licensed to provide for nursing or medical care.
“Here at Brentland Woods, doctors don’t do wound care. Those are services that a nurse would be offering,” Webb says. “So it’s one of the difficult challenges because what we have to do then is get a doctor’s order for a home-care agency to come out and do an evaluation, and that’s an insurance cost, instead of having a nurse be able to do that internally.”
And for that reason, often senior living agencies will offer various living choices that range from independent living to skilled nursing facilities.
“St. Ann’s is about being a continuum of care,” McRae says. “What we’ve been able to do is wrap services around individuals that live in these independent apartments to allow them to stay there much longer” before moving to assisted living, for example.
St. Ann’s has its own physician practice, McRae adds, called Pillar Medical Group.
“Rochester has many great geriatricians; we have many of the best geriatricians in our Pillar Medical Group, and they get to know the patients and their families and what their goals of care are, which is so important,” he says. “Our medical team follows them—they are part of the family. Because they are part of the continuum we can not only provide services and allow them to stay in their apartment, but if they do need to transition to a higher level of care we know the person and we’re able to help them transition through different levels of care.”
St. Ann’s has a medically complex and intense rehab unit, McRae says, as well as an advanced wound center on site that treats both residents and people from the community. Its Pillar Medical Group has been such a success that St. Ann’s has teamed with Episcopal SeniorLife, which has a similar continuum of care philosophy, to provide medical direction and care to its residents as well, McRae notes.
Friendly Home’s vice president and administrator Mike Perrotta says it’s understood that skilled nursing is the “option of last resort,” but taking a holistic approach helps the elderly move through the senior living spectrum.
“Helping people to age successfully really becomes a community effort,” Perrotta says. “We’ve already started to see that transformation, and I think that will just accelerate as that generation starts to move through the system.”
Schabel says the biggest piece that nursing homes have provided over the last decade or so has been an ability to provide very skilled care for people who are too well to be in the hospital, but too sick to be at home, bridging that gap effectively and efficiently.
“Decades ago people didn’t have any options. If you couldn’t be independent at home you had to go to a nursing home. That was sad because people weren’t supported in the best way they could be,” Schabel says. “Now, with the broad range of services available, it’s not where your only option is a nursing home.”
In fact, Schabel adds, Rochester has a plethora of agencies that can accommodate residents on ventilators and a number of mobile technologies such as X-rays, ultrasounds and medical testing also are available. And they can be done in a timely manner.
“Assisted living didn’t exist a couple of decades ago, and now it’s developing into an extremely supportive environment, a healthy human habitat, where people can get their needs met and still really enjoy a lot of life,” Schabel says. “And nursing homes—they’re starting to become more and more like mini-hospitals with the intensity of clinical care that they’re able to provide.”
McRae says Rochester’s elderly are fortunate to have a great depth of senior care available to them.
“A lot of people worry when they move to a community, how are the schools? What is the crime rate? Do I have employment opportunities,” he says. “Not a lot of people say, if this works out really well and I’m going to live the rest of my life here, am I going to be able to age well here? And you can in Rochester.”
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