Study Calls for Action on Creating Senior Housing for Middle-Income Seniors

Published in the Woonsocket Call on August 18, 2019

A recently released report sends a stark warning to federal and state policy makers and to the private senior housing sector. The report forewarns that in the coming years, a large number of middle-income seniors, who need assisted living with supportive services, will be priced out of this level of care.

Seniors housing in the United States is paid out of pocket by seniors with sufficient assets. A relatively small percentage of Americans have long-term care insurance policies to defray the costs. For seniors with the lowest incomes, Medicaid covers housing only in the skilled nursing setting, but increasingly also covers long-term services and supports in home and community-based settings. Programs such as low-income housing tax credits have helped finance housing for economically-disadvantaged seniors.

The researchers call on the government and the senior housing sector to step up and to assist the projected 14.4 million middle-income people over age 75, many with multiple chronic conditions, who won’t be able to afford pricey senior housing.

According to this first-of-its-kind study that appears in the April 24 2019 edition of Health Affairs, 54 percent of middle-income older Americans will not be able to meet yearly costs of $60,000 for assisted living rent and other out-of-pocket medical costs a decade from now, even if they generated equity by selling their home and committing all of their annual financial resources. The figure skyrockets, to 81 percent, if middle-income seniors in 2019 were to keep the assets they built in their home but commit the reset of their annual financial resources to cover costs associated with seniors housing and care.

Accompanying the senior housing study are two perspective pieces in Health Affairs on how society can adapt to aging and supporting aging in communities.

The study, “The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care, was conducted by researchers at NORC at the University of Chicago, with funding provided by the National Investment Center for Seniors Housing & Care (NIC), with additional support from AARP, the AARP Foundation, the John A. Hartford Foundation, and The SCAN Foundation.

Learning About the Needs of the Emerging ‘Middle Market’

“We still have a lot to learn about what the emerging ‘middle market’ wants from housing and personal care, but we know they don’t want to be forced to spend down into poverty, and we know that America cannot currently meet their needs,” said Bob Kramer, NIC’s founder and strategic adviser in a April 24, 2019, statement. “The future requires developing affordable housing and care options for middle-income seniors. This is a wake-up call to policymakers, real estate operators and investors,” he adds.

The report notes that significant financial challenges are expected to coincide with many middle-income seniors seeking seniors housing and care properties due to deteriorating health and other factors, such as whether a family member can serve as a caregiver. The study projects that by 2029, 60 percent of U.S. middle-income seniors over age 75 will have mobility limitations (8.7 million people), 67 percent will have three or more chronic conditions (9.6 million people), and 8 percent will have cognitive impairment (1.2 million people). For middle-income seniors age 85 and older, the prevalence of cognitive impairment nearly doubles.

The researchers say that this ‘middle market’ for seniors housing and care in 2029 will be more racially diverse, have higher educational attainment and income, and smaller families to recruit as unpaid caregivers than today’s seniors. Over the next 10 years, growth in the number of women will outpace men, with women comprising 58 percent of seniors 75 years old or older in 2029, compared to 56 percent in 2014, they say.

Bringing the Public and Private Sector Together

“In only a decade, the number of middle-income seniors will double, and most will not have the savings needed to meet their housing and personal care needs,” said Caroline Pearson, senior vice president at NORC at the University of Chicago and one of the study’s lead authors.

“Policymakers and the seniors housing community have a tremendous opportunity to develop solutions that benefit millions of middle-income people for years to come,” says Pearson.

Researchers say there is an opportunity for policymakers and the seniors housing and care sector to create an entirely new housing and care market for an emerging cohort of middle-income seniors not eligible for Medicaid and not able to pay for housing out of pocket in 2029.

The study’s analysis suggests that creating a new ‘middle market’ for seniors housing and care services will require innovations from the public and private sectors. Researchers say the private sectors can offer more basic housing products, better leverage technology, subsidize ‘middle-market’ residents with higher-paying residents, more robustly engage unpaid caregivers, and develop innovative real estate financing models, among other options.

As to the public sector, the researchers call on government to create incentives to build a robust new market for middle-income seniors by offering tax incentives targeted to the ‘middle market,’ expanding subsidy and voucher programs, expanding Medicare coverage of nonmedical services and supports, creating a Medicare benefit to cover long-term care, and broadening Medicaid’s coverage of home and community-based services.

“This research sets the stage for needed discussions about how the nation will care for seniors who don’t qualify for Medicaid but won’t be able to afford seniors housing,” said Brian Jurutka, NIC’s president and chief executive officer. “This discussion needs to include investors, care providers, policymakers, and developers working together to create a viable middle market for seniors housing and care,” he says.

Adds, Lisa Marsh Ryerson, President of AARP’s Foundation, “All seniors want to live in affordable, safe and supportive housing, and more than 19 million older adults are unable to do so. We must act now to implement innovative solutions – including robust aging-in-community efforts – to accommodate what is sure to be an increasing demand for housing that meets the needs of older adults.”

Is Rhode Island prepared to meet the senior housing needs of the state’s middle-income seniors in 2029? If not, the state’s federal delegation, lawmakers, state policy makers and the senior housing industry must begin to chip away at this looming policy issue.

To view the study, go to http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05233.

Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

AAIC 2019 Concludes, Researchers Share Findings to Combat Alzheimer’s disease

Published in the Woonsocket Call on July 20, 2019

Thousands of the world’s leading professionals, involved in dementia care and neuroscience research, came at the Los Angeles Convention Center from July 13 to July 18, 2019, to attend the Alzheimer’s Association International Conference® to learn about the findings of the latest Alzheimer’s disease clinical trial and a government-driven public/private initiative to speed them up.

AAIC® is considered to be the largest and most influential international meeting with a mission to advancing dementia research. Every year, AAIC® brings together the world’s leading basic science and clinical researchers, next-generation investigators, clinicians and the care research community, to share research findings that’ll lead to methods of preventing, treating, and improving the diagnosis of Alzheimer’s disease.

“It is clear, and has been for some years that the (Alzheimer’s) field needs to explore other options, and diversify the portfolio of targets. A renewed energy has been brought about by a fivefold increase in Alzheimer’s research funding at the federal level. These gains will propel already-established efforts by the National Institute on Aging, Alzheimer’s Association and others to diversify (therapeutic) targets,” said Maria C. Carrillo, Ph.D., Alzheimer’s Association chief science officer, in a July 17 statement publicizing research findings from the international conference.

Hundreds of Findings of Clinical Trials Shared

According to the Chicago-based Alzheimer’s Association, “a record number of scientific abstracts – more than 3,400 – were submitted to AAIC this year, including 229 abstracts with results from or descriptions of Alzheimer’s clinical trials. AAIC 2019 also spotlighted three clinical trials using innovative methods and targets.”

At AAIC 2019, attendees were updated about the activities of the Accelerating Medicine Partnership-Alzheimer’s Disease (AMP-AD), a partnership among government, industry, and nonprofit organizations (including the Alzheimer’s Association) that focuses on discovering, validating and accelerating new drug targets. The Alzheimer’s Association says that this $225 million research initiative is made possible through the highest-ever levels of U.S. federal funding for research on Alzheimer’s and other dementias, approved and allocated in the last five years.

“This is an example of how the government and private entities and researchers can work together [via AMP-AD funded studies] on providing the resources necessary to expand our abilities to test new drugs and find a treatment for Alzheimer’s disease, and, hopefully find a cure,” said Donna M. McGowan, Executive Director of the Alzheimer’s Association, Rhode Island Chapter. “Rhode Island has tremendous researchers, and they are at the forefront of this initiative. they need the tools to increase their scope of work.”

Adds Maria C. Carrillo, Ph.D., Alzheimer’s Association chief science officer, “It is clear, and has been for some years that the field needs to explore other options, other avenues, and diversify the portfolio of targets. A renewed energy has been brought about by a fivefold increase in Alzheimer’s research funding at the federal level, achieved largely due to efforts by the Alzheimer’s Association, the Alzheimer’s Impact Movement, and our ferocious advocates. These gains will propel already-established efforts by the National Institute on Aging, Alzheimer’s Association and others to diversify the portfolio of drug targets for the scientific community.”

The achievements of the AMP-AD Target Discovery Project were highlighted in a series of presentations by the leading AMP-AD investigators at AAIC 2019.

One study noted for the first time, 18-month results from an open-label extension of inhaled insulin in Mild Cognitive Impairment and Alzheimer’s including significant benefits for memory ad thinking, day to day functioning, and biological markers of Alzheimer’s.

Another described a newly-initiated 48-week Phase 2/3 clinical trial of a drug targeting toxic proteins released in the brain by the bacterium, P. gingivalis, generally associated with degenerative gum disease. Previous research findings identified the bacterium in brains of more than 90 percent of people with Alzheimer’s across multiple studies and demonstrated that infection may trigger Alzheimer’s pathology in the brain.

Can lifestyle Interventions Promote Brain Health?

There was also an update on the Alzheimer’s Association U.S. Study to Protect Brain health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) study, now up and running in multiple locations. The U.S. POINTER is a two-year clinical trial to evaluate whether intensive lifestyle interventions that target many risk factors for cognitive decline and dementia can protect cognitive function in older adults at increased risk for cognitive impairment and dementia. Researchers will compare the effects of two lifestyle interventions on brain health in older adults at risk for memory loss in the future. The U.S. POINTER is the first such study to be conducted in a large group of Americans across the United States.

The researchers say people age 60 to 79 will be randomly assigned to one of two lifestyle interventions. Both groups will be encouraged to include more physical and cognitive activity and a healthier diet into their lives and will receive regular monitoring of blood pressure and other health measurements. Participants in one intervention group will design a lifestyle program that best fits their own needs and schedules. Participants in the other intervention group will follow a specific program that includes weekly healthy lifestyle activities.

Laura Baker, Ph.D., associate professor of gerontology and geriatric medicine at Wake Forest School of Medicine, and one of the principal investigators of the U.S. POINTER study, said, “Lifestyle interventions focused on combining healthy diet, physical activity and social and intellectual challenges represent a promising therapeutic strategy to protect brain health.”

“U.S. POINTER provides an unprecedented opportunity to test whether intensive lifestyle modification can protect cognitive function in older Americans who are at increased risk of cognitive decline and dementia,” Baker added.

“We envision a future where we can treat and even prevent Alzheimer’s through a combination of brain-healthy lifestyle and targeted medicines, as we do now with heart disease,” Carrillo said. “We hope to prevent millions from dying with Alzheimer’s and reduce the terrible impact this disease has on families.”

For more details about research findings presented at AAIC 2019, http://www.alz.org/aaic