2015 Business Outlook: Service reach
Editor's Note: Senior housing and services providers will enter 2015 with many unanswered questions regarding their future. A new Republican majority in the U.S. Senate, an expanded Republican majority in the U.S. House of Representatives and the presence of Republican governors in more states will bring new perspectives to the political landscape. Controversial presidential executive orders related to immigration reform await resolution, and threatened governmental action could overturn some or all of the Affordable Care Act and the health insurance it provides to certain seniors and others. New payment models and regulations under consideration could alter the business climate for years to come. In a multi-part series, Long-Term Living takes a look at some of the top issues that those who serve older adults will face in the new year. This installment is part two. Read the entire series here, or see the digital edition of the December 2014 issue for the print version of these and related articles.
Senior housing and services providers increasingly are adapting their offerings in response to the desire of older adults to “age in place,” wherever they are. For instance, more than 70 percent of LeadingAge members are involved in home- and community-based care, says Larry Minnix, president and CEO of the organization. “I’m amazed every time I turn around and hear about somebody that has a really strong institutional base that’s now already into various kinds of home-based services,” he says. The trend even resulted in LeadingAge changing its business model, defining membership based on total service revenue rather than number of beds and apartments, Minnix says.
Nursing home and continuing care retirement community efforts to offer services to those in the neighborhoods in which they are located are primarily local endeavors at this point, LeadingAge Senior Vice President of Public Policy and Advocacy Cheryl Phillips, MD, says. “But I think it’s going to be more and more common in the next five years, for a number of reasons,” she adds. “States are looking at ways of paying for long-term services and supports [LTSS], and healthcare systems are recognizing that if you give the services that people need in the communities that they already are living in, they tend to use fewer healthcare dollars, because their needs are met better.”
Payment for services remains a challenge for potential clients, however, Phillips says, especially for middle-income seniors who don’t qualify for Medicaid. “In the short term, we’re struggling at state levels for how to better serve these people without them having to spend down and resort to Medicaid,” Phillips says. “In the long run, we have to figure out as a country how are we going to pay for LTSS.”
LeadingAge’s Pathways project outlines seven potential ways to pay for LTSS. “We’re continuing our study into the various alternatives and what the financial implications of those are,” Minnix says. “There are solutions that are economically and politically palatable.”
Assisted living residents increasingly are seeking to age in place, too, says Maribeth Bersani, senior vice president for public policy and interim CEO of the Assisted Living Federation of America (new President and CEO James Balda is expected to begin his duties Jan. 15). “A real challenge now is making sure that all the state laws and regs allow our members who do want to care for residents through the end of life to have the opportunity to do so,” Bersani says. “And it means taking care of people who are nonambulatory, it means working with hospice and it means really paying more attention to palliative care…[and] helping people die the way they want to die.”
Assisted living residents’ wishes to age in place also means that memory care is increasingly part of communities’ service mix, in some cases changing the physical environment, Bersani says. “We are seeing an expansion of dementia providers, people taking some of their assisted living beds and turning wings or different floors into dementia care. There’s a huge need.”
Regarding service provision in the greater community, Phillips says that a priority for LeadingAge is integrating services for low-income seniors and affordable housing. “I would say the biggest challenge is affordable housing,” she adds, because providers face “drastically eliminated” funds from the U.S. Department of Housing and Urban Development via Section 202 and Section 8 subsidies. “It’s really hard to talk about integrating services into senior housing if you don’t have access to the housing,” Phillips says. “If we don’t have access to affordable housing, which means then we don’t have a place to bring in services, what we end up doing is driving the Medicaid costs for nursing homes up, because that is the default safety net that most states have in place.”
In an effort to expand affordable housing opportunities for older adults across the country, earlier this year LeadingAge welcomed Niles Godes as its first senior vice president for housing and capital. He is working with members of the national aging services provider association, policy makers and private-sector partners. (Read our exclusive interview with Niles Godes here.)
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