What Interested Me About Senior Living?

040111.01TearoffSheetI have written this brief essay in response to a fund-raising effort for the cure of Alzheimer’s disease. Several of us were asked by Symbria colleague, Dr. Lori Stevic-Rust, to respond to the question, how did you become interested in the senior living industry?

The Symbria Advisory Services team is sponsoring Lori’s Walk to End Alzheimer’s®, the nation’s largest event to raise awareness and funds to fight Alzheimer’s disease. Please click on the pic above to join us in sponsoring her efforts!

What Interested Me About Senior Living?

Candidly like many people, I’m not sure it was my interest that got me started.

I was a young man with a young family and just trying to make a living. What interested me most at that time was a steady paycheck and the hopeful ability to grow into a career – whatever that meant. What caused me to stay in senior living for the past 25 years – now that I think might be worth sharing.

To me, one of the greatest advantages of being a management consultant in the senior living industry is performing site visits. Being able to travel around the country and tour different communities in different geographies; seeing the good, the bad and the regrettable. Being reminded of the work direct caregivers do every day and that mine, at best, is a supporting role backstage.

On one such occasion I found myself in New Jersey at a senior living community near to the Atlantic Ocean. It was late afternoon on a clear winter’s day, and shadows from the trees outside were inching their way across the lobby floor. I sat there admiring the beauty of a crisp, amber sky, satisfied I had completed a good day’s work. I only needed to touch base with one more staff person, and I would be on my way – back to the hotel to write up my notes and then off to explore the local area.

As I was waiting there a couple was approaching from down a long hallway toward me. They were of an age where I surmised they could be (likely were) residents of this assisted living community. Maybe they were heading out to do some exploring too. I felt happy that I had some small part in this image – part of an industry that provided a secure, caring and loving environment for this couple. That they could enjoy the fullness that life had to offer together in the twilight of their lives.

They were holding hands as they came down the hall, and as they grew closer I noticed the woman had a somewhat distant expression – a mix of forlorn and bewilderment. Her partner’s expression seemed to be one of melancholy and concern, yet stoic determination. His shoulders were a bit slouched, and I don’t know why but I did not think it owing simply to an aging posture.

There were clearly some emotional undertones here that made me quickly challenge my exploration hypothesis. Then as they neared the door it dawned on me the woman wasn’t dressed near appropriately enough to be going outside on this frigid afternoon in mid-February.

That’s because she wasn’t. And then what followed was a scene that has yet to be eclipsed in my mind by any other for its sheer heartbreaking sadness and poignancy. I can still hear their words as if they were spoken only yesterday.

“Bill, take me home . . . take me home, Bill . . . Bill, this isn’t my home . . . I want to go home, Bill . . . please, Bill! Why won’t you take me home?”

“It’ll be okay, Alice . . . it’ll be okay . . . you’re going to be fine . . . I will see you tomorrow, I promise.”

The elderly gentlemen tried earnestly, with the calmest and most serene expression as tears were welling up in his eyes to explain why this was her home now. This was, “where she needed to be.” He was unable to leave without the assistance of an aide having to gently redirect his wife. I glanced over at the receptionist who, like me, had sat silently taking this all in – wondering whether she could see I was fighting back tears. Her own only made my efforts more impossible.

The separation we had witnessed was like what one might observe at a daycare or preschool between child and parent. I would guess the relative emotions might be quite similar too: fear, anger, regret, sadness. But when a parent or guardian shows up in the afternoon, the reunion is a joy to see: an emotional reversal, all secure in the knowledge the family will be reunited at home that evening.

Bill’s wife was not going home. She had Alzheimer’s disease, and though Bill had tried to care for her at home he was unable to do so without risking injury to her or himself. She was, “where she needed to be.” Quite obviously, she was not where anyone wanted her to be.

I once had a colleague who owned several assisted living properties share with me something he regularly explained to his sales staff. He would tell them, “never forget, that even on your most successful sale it is most likely your customer will not be getting what they want.” They want to stay home. Alice wanted to stay at home.

There are some five million individuals in the United States like Alice. This is a tough industry to work in when you take to heart the challenges these individuals, their families and caregivers face every day in the communities I am lucky enough to assist. And the challenges associated with Alzheimer’s disease are right up there at the top.

I could never do the work of the caregivers that labor tirelessly to ease whatever burden they can of those afflicted with Alzheimer’s disease and their families. So I do what I am able: try and help ensure their working environment is as unencumbered, encouraging and helpful as it might be. If I can do that, then I feel like I am contributing what I can – and that is why I have stayed in the senior living industry for the past 25 years.

Cheers,
  ~ Sparky

A Choice to Live

147391Participants at this year’s LeadingAge Annual Meeting in Nashville were treated on Sunday evening to the premier showing of Glen Campbell: I’ll Be Me. A documentary of the legendary country artist’s life with Alzheimer’s disease, the venue and audience chosen for the premier could not have been more perfectly selected.

The film artistically yet with faithful realism explores the many emotions that Alzheimer’s disease evokes – in the individual afflicted, as well as those who share life with that person. It chronicles what began as a 3-week goodbye tour turned into a 151-show theatrical phenomenon that became much more about celebrating life in whatever form it humanly manifests than succumbing to the sadness and regret of disease.

Alzheimer’s disease is unique in its ability to impact loved ones of the individual having the disease while stealing away that person’s ability to understand or empathize with those feelings. Glen Campbell and his family determined in 2011 that they would use their shared experiences to help build greater awareness and understanding of the disease.

Nationwide screenings of the film are set to launch this weekend. Grab yourself a box of tissues and go see it.

Cheers,
  ~ Sparky

The Rising Costs of Dementia Care

Research published today in the New England Journal of MedicineMonetary Costs of Dementia in the United States – describes the projected economic consequences of caring for an aging population afflicted with various forms of dementia, including Alzheimer’s disease.

Separating the caregiving related costs attributable to dementia is challenging, if not impossible, because of the prevalence of comorbidity in individuals having dementia and because of the lack of quantifiable data reflecting the financial burden associated with informal caregiving. Using data from the University of Michigan’s Health and Retirement Study, the study’s authors sought to adjust for such phenomena by parsing out data that is believed to reflect the marginal costs associated with dementia.

Their methodology looked at how these costs could vary over the spectrum of probability within a given population that an individual would be afflicted with dementia. Costs were stratified according to:
     Out of Pocket Spending
     Spending by Medicare
     Net Nursing Home Spending
     Formal and Informal Homecare

If the intuitive concern that the economic impact of an aging society will be dramatic, the aggregate cost projections from this research certainly reinforces that concern. With a prevalence rate of 14.7% of the US over the age of 70 having dementia, the current (2010) cost of care (not including the valuation of informal caregiving) is $109 billion. By 2040, if prevalence rates and utilization of non-informal services and care are held constant, that amount is projected to more than double.

The authors note that dementia is one of the most costliest diseases to society, yet 75% to 84% of attributable costs of dementia are related to institutional care (e.g., a nursing care facility) or home-based long-term care – i.e., as opposed to medical care. Healthcare providers in that space should recognize the challenges and opportunities of that consequence.

I think it is important to remember that the inherent subjectivity of the dataset – and the data elements represented – is a reality that cannot be overlooked. In addition, even if there wasn’t the inherent subjectivity, I’m not really sure of the article’s value, nor whether it is deserving of the attention received in the press. Perhaps there’s something there I missed.

Counting the number of teeth a shark has and noting their regenerative capabilities is a fascinating exercise, but it’s the shark that can kill you – not its teeth.

Cheers,
  Sparky

Special Note: last summer I shared with Pub visitors a webinar, Emerging Trends and Drivers in Dementia Care, presented by my Artower colleague, Lori Stevic-Rust, PhD ABPP, Board Certified Clinical Health Psychologist and nationally recognized authority on Alzheimer’s disease. Another plug here seems appropriate.

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