Changing Aging

This is a cool mission statement:

To transform a source (the knowledge, talent and skill of the region’s 50+ population) into a force for enriching our community by helping individuals find meaning and the means to contribute to the greater good.

It’s the mission of Coming of Age, a Philadephia collaboration of four partners:  Temple University’s Center for Intergenerational Learning, WHYY Wider Horizons, the United Way of Southeastern Pennsylvania, and  AARP Pennsylvania. 

Coming of Age has three objectives: 

1.  Helping people age 50+ plan for the future;

2.  Promoting 50+ volunteering, learning, and community leadership;

3.  Working with nonprofits to recruit, train, and retain 50+ volunteers.  

Coming of Age is a great model for other communities who want to seize opportunities of an unprecedented age wave.  It’s fresh, invigorating, inspiring, fun . . . It’s also drawing dollars . . . Atlantic Philanthropies recently gave it $1.8 million to expand in other parts of the U.S.. . . . .

Do you know of any other communities that are doing this?

Just when you think there aren’t issues that Red and Blue America can agree on, there comes this little thing called aging that we’re all doing and want to do well. 

On Wednesday a packed auditorium at the University of Minnesota Humphrey Institute of Public Affairs participated in a discussion about financing long-term care in America. And what one saw was a great issue opportunity for Red and Blue America to forge common ground.  As several panelists, including a Republican state legislator, said: Aging isn’t a Republican or Democratic issue.

The forum was sponsored by the Minnesota Health and Housing Alliance, the American Association of Homes and Services for the Aging and AARP.  Twin Cities Public Television is creating a one-hour special on it and we’ll post that when it comes out later this year. 

In upcoming posts we’ll look at finance plans introduced at the Forum, but first, following are several highlights/themes from the discussions moderated by Minnesota state commissioner of labor and industry Steve Sviggum and Larry Jacobs, director, at the University of Minnesota’s Center for the Study of Politics and Governance.  I know a number of Changing Aging readers were there, so please share what you found interesting or heard differently . . . thanks.

- Environments are Disabled:  Jan Malcolm, CEO of Courage Center, put a different paradigm on disability.  Too often people live in environments that don’t allow for people with physical challenges.  So why do we always focus on the person’s physical disability? Why aren’t we focusing on maximizing the physical environment in our communites to allow people young and old to live easily where they want to? 

- Money Has to Follow the Person:  With government reimbursement money encumbered and siloed in so many areas of health care, people are mice in a never-ending maze, captive to running to the cheese (fragmented, inflexible funding sources).  Let the money follow the person, so they can make the choices in their care and service options. 

- A Healthy Health Care System in America Must Include Aging Services:  If we’re going to truly have a well-coordinated cradle-to-grave health care system that focuses on wellness, aging services must be an essential piece of the solution wheel. We have to connect the dots.

- New Language:   What do you think of when you think of long-term care?  Many people think “nursing homes.”  Guess where people don’t want to live? Long-term care, er, aging services encompasses so much more than a nursing home, including:  assisted living, rehab services, wellness centers, transportation, home care, memory care, technology . . . .

- Home-Centered System:  Home has to be an integral part of public policy innovation.  Because that’s where people most want to be.  Nursing homes will still have an integral role, but they will look very different. 

- This is a [Fill in the Blank] Issue:  Long-term care isn’t just a long-term care issue.  It’s a health care issue, business issue, education issue, economic security issue and community development issue.  If we don’t ride the age wave, it’s going to damage other sectors of our communities.

- Marry Technology and Results:  We spend billions in America on technology in hospitals, attempting to help people live longer.  What about adding life to years?  Technology in aging services, such as sensors in people’s homes that spot small health problems before they grow into big ones, is the preventive-type of technology we should be focusing on in a results-based, wellness-focused health care system.

- Fiscal Responsiblity Doesn’t End with the Mortgage:  To save safety nets for those truly in need, more of us simply have to plan ahead and pay our way for aging services.  The alternative is not sustainable for America.

The Washington Post calls Time Goes By “the quintessential seniors’ blog,”  . . . AARP calls its author Ronni Bennett (in the cool photo montage above), “the dean of older bloggers,”  . . . And we’re fortunate to have her insights today at Ecumen’s Changing Aging blog.

For more than 25 years Ronni, who says “Age is a gift,” was a radio and television producer, working on such programs as 20/20 and the The Barbara Walters Specials on ABC and for shows on Lifetime TV, NBC, PBS and CBS.  In 1996, as the Internet was in its infancy, Ronni was named the first managing editor at cbsnews.com.  It was there that the seeds of Time Goes By began to grow.  Today she’s changing aging in America from her home in Maine where she authors her groundbreaking blog.  Thank you to Ronni for taking time with us.

Why did you start blogging?

After six or eight years of researching aging in my spare time, I had accumulated thousands of pages of notes and articles along with a small library of books on aging and wanted to organize what I’d learned. I had also been following what was, in 2003, the nascent blogging phenomenon and thought it would be a good format for writing about ‘what it’s really like to get old’ which is the subtitle of my blog.

Hardly anyone was writing online about aging back then and what existed - online and in print - was about 95 percent negative; all about decline, disease and debility. I knew getting old couldn’t possibly be as bad as that so while not being a Pollyanna about it, I wanted to explore what is good about aging.

How much time do you spend on Time Goes By?

It’s a seven-day-a-week job. I have a couple dozen Google Alerts of key words and phrases that keep me up on what’s being written about aging, aging news, research, etc. I also subscribe to email newsletters relating to geriatrics, technology, government, public policy, employment, age discrimination, caregiving, etc., so there’s a lot of reading and assimilating to do. Then the writing.

I post to Time Goes By six days a week and I also keep a secondary blog, The Elder Storytelling Place, for which I rarely write, but edit and publish stories elders submit. I put in a lot more time on these than I did on regular jobs before I retired from the workplace.

What kind of impact do you think the blogosphere is going to have on how we view aging in America?

There’s a famous New Yorker cartoon from about a dozen years ago showing two dogs sitting at a computer. One says to the other: ‘On the internet, no one knows you’re a dog.’ Well, no one knows your age either, unless you tell them, so one’s thoughts, opinions and writing can more easily be judged on their merit rather than being dismissed for being written by a 70-year-ol. Or a 20-year-old, for that matter.

However, I always give my age, when appropriate, on my blog and I urge other elders to do it too so that readers become accustomed to finding stories of interest from 60-and 70- and 80-year-olds and beyond. The United States is a profoundly ageist country in which, for years, elders have been marginalized in media, the workforce and most of the culture as though, when we get old, we forget everything we ever learned. But we still have much to contribute if people will let us, and perhaps within the blogosphere we - the young and the old - might discover what we have in common.

Does growing older fascinate you, or scare you, or something else?  Why?

For most of my life, I never thought about getting old. I think our mid-years are so busy with careers, home, child-raising that there’s little time to consider our approaching later years. In my case, I was 55 when I looked around the room where I worked at cbsnews.com for one of the writers I needed to speak with. As I gazed over the faces, I had a startling moment of recognition: I was older than every person in the room by decades, old enough in some cases to be their grandmother.

Over the next few weeks, I noticed it again and again and realized I knew nothing about what getting old is like. A cursory look at the popular press, newspapers and magazines, gave me nothing except the debility and decline I mentioned above and I thought if it was going to be THAT bad, I might as well shoot myself.

But I couldn’t make myself believe that it would necessarily be so terrible. I was smarter, sharper, better at my job than I had ever been. I was more comfortable in my own skin. I was happier with myself than when I was younger. How could being 55 and even older be the awful thing it is made out to be, I wondered, when I felt so good.

Because youth is considered the gold standard of life in the United States, getting old is a great mystery and it fascinates me. And the goal of my blog is to lift the veil on that mystery and find out what it’s really like.

How do you see the age wave - the unprecedented number of older people - changing how we view aging in America?

Well, I haven’t made up my mind about that. On the one hand, with more elders around, everyone else has to become more familiar with us and see the trade-offs that are made. I can’t run as fast or jump as high as I once could, but I’m smarter, more experienced and have a lot better judgment than when I was young.

On the other hand, I worry that there will be a generational conflict. There is no denying that as old people become a larger percentage of the population, some people will see the need to care for those who need it as a drain on resources.

Nevertheless, things will need to change. With fewer people in the generations coming up behind the baby boomers, finally corporate America will NEED to employ old people longer just to get the work of the country done. Life expectancy increased by 30 years during the 20th century and we are much healthier than our parents’ and grandparents’ generations.  So there is no reason old people should be shoved out of the workplace at 60 or 65 as they are now, and there are signs that corporate America is beginning to recognize this.

The generations need one another and I hope that will help change the ageist atmosphere we live in now.

Do you see the media changing how it views and depicts aging?

A little, but not much yet. This is so because most of the media is run by young people and they don’t understand old people. Our interests and concerns change as we get older, but the media treats us mostly as slightly dotty, none too bright and the youth and beauty police keep insisting that we do everything possible to pretend to be younger than we are. The ad agencies and TV and movie producers need to employ some 60- and 70-year-olds to get it right.

There are a few more magazines, such as More and ELDR aimed at older people, and that’s good except that they may be becoming kind of a ghetto of old people media. And Oprah Winfrey, who has millions of fans and is considered the queen of daytime television, spends a great amount of time on her show pursuing the pretense of youth. Oprah is 54 years old. She should be wise enough by now to use her media power to help people accept aging as a normal stage of life, promote its dignity, recognize the value of elders and help integrate them into the mainstream.

Which are you enjoying more - your career in your 30s or your work today?

I had a wonderful career in television. I traveled the world on someone else’s dime, worked with kings and queens and movie stars and heads of state, and learned a lot of things I would never have otherwise known. And then, after a couple of decades, I was given the opportunity to work in a burgeoning new medium, the internet, when it was brand new.

During all those years, I never thought much about what I’d do when I wasn’t employed in the workforce anymore. I suppose I expected to do that until I die, but a bit of age discrimination in the workplace got in the way. I hadn’t intended, when I started Time Goes By, to make it a late-life career, but it morphed into that. It’s allowed me to meet people from all over the world, get to the know the tech community and participate in the blogging world beyond turning out a blog post each day, attending and speaking at conferences and, perhaps, making some small difference in how elders are perceived and treated.

So I can’t say I enjoy one more than the other, but how lucky for me that the internet and blogging came along just when I needed it.

It’s unreal how so many companies are scared of people - even their own people.  Yet people are their business.  Starbucks sees the power of people with their new consumer “idea generator” website.   I don’t like coffee, but I like what they’re doing.

At Ecumen, we also find that the best ideas come from people who know us best - Ecumen customers and Ecumen employees.  The power of people is the genesis behind Ecumen’s Innovation Station.  (note: this is a PDF link)

Housed on our intranet, it’s where teams of people shape new ways of doing things.  Last week was our annual celebration recognizing innovators, who have done a variety of things to improve the customer experience, including:

- Specialized behavioral Alzheimer’s training
- A new memory care community for people dealing with the most serious behavioral issues caused by Alzheimer’s, there are only 2 in Minnesota and a handful nationally
- New congregational senior housing.
- Expanding outside bricks and mortar to provide seamless care in a person’s home
- Expansion of technology such as wireless record keeping of care (no more paper) and
- Universal marketing, when a person walks into an assisted living community, everyone is empowered and trained to serve that person and provide a tour
- Making it possible for nursing home residents to eat when they want to eat, what they want to eat (No institutional 7 a.m. wake up call and everyone going to the dining line at once . . . yuck)
- Concierge service so that our customers have point of contact when they seek a service
- Going green . . .the only paper products that Country Neighbors of New Richland, Minnesota, uses are recycled paper towels
- “Guest” apartments so that potential customers can “test-drive” our communities
- Retrofitted dining trays for a person’s walker to enhance independence and allow a person to fully participate in buffet-style dining
- End of life care that underscores aging is all about living even at the very end of life.

THE POWER OF PEOPLE - WHAT POSSIBILITIES

“After going from crisis to crisis, Joan is finally in a place where they have the time and training to really help,” said her husband, Terry, 76, a retired math teacher and businessman from Shoreview.  “How many places can you get kicked out of?  Let’s see, for us it was four in one year.” . . . .

Today the Minneapolis Star Tribune told a wonderful story of Ecumen’s Summit House at Prairie Lodge, a new option in Brooklyn Center, Minn., for people and families dealing with the extreme behaviors that at times accompany Alzheimer’s.   Thank you to the Wagener family for choosing Ecumen’s new housing option and being so candid about telling this powerful story.  We salute you!

“Drugs may be a good answer, but it should never be the first answer,” said Janelle Meyers, Ecumen’s director of Prairie Lodge.  “A resident isn’t trying to be nasty or disruptive.  It’s the disease talking.  If someone is screaming, they’re trying to communicate something.  We need to figure out what that is.”

Above are just a few of the innovators (several of whom are pictured at last week’s Ecumen Leadership Conference) who sought a new way to help people and family members dealing with the most extreme behaviors of Alzheimer’s.  They are part of an incredible team of people throughout this organization who are delivering a beautiful vision for “Changing Aging”:

We envision a world in which aging is viewed and understood in
radically different ways.

You might have read our post the other day about a Duluth News Tribune “story that missed the story” about Ecumen’s work in Duluth. Below is an op-ed authored by Ecumen CEO Kathryn Roberts and Lakeshore volunteer community board chair John Hyduke that provides context that was missing in the original story. It was published in yesterday’s Duluth News Tribune:

Care systems should foster self-empowerment
Kathryn Roberts & John Hyduke, Duluth News Tribune
Published Sunday, May 11, 2008

Leadership isn’t easy. Sometimes stones get thrown at you. That’s what happened to Lakeshore, its parent organization Ecumen and all aging services and health care innovators in the May 4 News Tribune (“Profits before patient care?”).

In Ecumen’s crystal ball, we see a state and country that rides the unprecedented age wave. We see people having opportunity to live at home to the very end of their lives. And we see a seamless, integrated health care system that delivers the right care in the right place at the right time.

We see that future because we are helping shape it in Duluth and elsewhere.

Most people don’t need long-term care and government-funded million-dollar nursing home stays. But serious disconnects in our patchwork health system often lead to institutionalizing people, over medicating, draining human will and devouring public dollars.

Several years ago Ecumen had a decision to make: tear down the outdated Lakeshore nursing home and sell the lakeside land on London Road to a developer to build homes, or move forward and serve seniors and others in new ways.

Duluth has plenty of nursing homes that provide long-term care. We focused on an area of need not being fully met: short-term care and rehabilitation.

In our vision, people move much more easily and with greater confidence from the hospital to coordinated care and services. A nursing home becomes a specialized medical respite center for rehabilitation and chronic care management, not an under-funded, antiquated institution where someone recovering from a hip replacement shares a wing with an Alzheimer’s patient, as is all too often the case today.

In our vision, care is fully funded. Now, government funds don’t cover costs of providing care at traditional nursing homes. In fact, many of Minnesota’s government-funded nursing homes operate with less than 10 days cash on hand. A choice between payroll and innovation is no choice.

Instead of selling the land on London Road, we decided not only to build new buildings, but a new way to deliver care in Duluth. We replaced an outdated nursing home with a new neighborhood that has a short-term care center, and independent, assisted living, and memory care apartment homes.

At the short-term care center, our entire focus is getting people better to go home. It serves people — of all incomes — with short-term care and rehabilitation, not long-term care. It’s a specialty center, just as there are specialty centers for oncology, child care and others. If a person needs more intensive care in a health care setting, we can coordinate it at Bayshore, which is an Ecumen-managed nursing home. We’re creating a true continuum of care.

Ecumen will never build another institutional nursing home. Our society doesn’t want it. And our customers and we don’t want Lakeshore to be another traditional nursing home. That’s why we’re decertifying from Medicaid, which pays for most Americans’ long-term care nursing stays. We will continue serving all income levels at Lakeshore’s short-term care center, but we will do it under Medicare. People who want to stay beyond their Medicare benefit will by law be given the option to pay just as they would do if they wanted to stay in a hospital beyond their regular stay. But the fact is, most people don’t want to stay in a hospital or at our short-term care center long-term because they want to go home or more independent setting.

Across this country people want a care system that leads with self-empowerment, is more integrated, proactive, and is focused on getting people back to where they most want to be: home. And at Ecumen, we are working hard to make that happen.

Kathryn Roberts of the Twin Cities is president and CEO of Ecumen, which manages Lakeshore, Bayshore, Lakeland Shores Apartments and the Chris Jensen Health and Rehabilitation Center in Duluth. John Hyduke of Duluth is the community board chairman of Ecumen’s Lakeshore community and is president of WestmorelandFlint.

Sometimes leadership isn’t easy.  Sometimes you get arrows shot at you.  That’s what happened to our colleagues at the Ecumen community of Lakeshore in Duluth, Minnesota (and all of us who are working on creating new and better aging services) in an ugly article on the front page of Sunday’s Duluth News-Tribune by a reporter who doesn’t hold the same crystal ball that we do . . .

What We See in Our Crystal Ball

- A U.S. health care system that is completely integrated (a real system, not a bunch of fragmented “stuff”) and provides the right care at the right time in the right place.

- A care system that doesn’t unnecessarily institutionalize people.  This happens too often, draining a person’s will and public dollars.

- Nursing homes that are specialized medical respite centers for rehablilitation and chronic care management, not under-funded, antiquated institutions where someone recovering from a hip replacement shares a wing with an Alzheimer’s patient (which also happens all too often today).

What We Did Because of What We See

- In Duluth, we tore down a 1950s-style nursing home.  Instead of selling the valuable Lake Superior shorline to a developer, we built a new neighborhood (but also a new way to deliver services) that has a short-term care and rehabilitation center, independent living, assisted living and memory care apartment homes. 

- We serve many different people there (and all incomes) but our short-term care center is exactly that, it’s for short-term stays.  It fills a service need in the community that wasn’t served previously. We want that short-term care center to be known as the place where people come to to get better and go home.  And we’re succeeding.

- If a person needs long-term intensive care, we coordinate that at an Ecumen-managed nursing home in Duluth: Bayshore.  Of the 700 people we served in short-term care last year, only 30 went to a nursing home.  The rest went home or to assisted living.  This is moving toward an integrated system that we envision.

- Because there is no federal classification for this new short-term care and rehab product, we have to license it as a “skilled nursing facility” or a nursing home.  We don’t want to create another nursing home.  Duluth has plenty.  Consequently, we’re decertifying from Medicaid, which pays for most Americans’ long-term care nursing stays.  We will continue serving all income levels at Lakeshore’s short-term care center, but we’ll do it under Medicare.  People who want to stay beyond their Medicare benefit will have the option to pay just as they would do if they wanted to stay in a hospital beyond their regular stay.  Fact is most people don’t want to stay in a hospital or at our short-term care center long-term because they want to go home.

This is the right approach to get to the vision we see in our crystal ball.  You can read the reporter’s interpretation below.  This isn’t the case where the truth lies somewhere in the middle.  He missed the story.

What the Reporter Saw

“They felt they could make it work,” Peer said. “I thought, ‘That’s not what I’m seeing, but I’m not the expert.’ ”

About 10 days later, Wick had another stroke. He’s now in a nursing home where he can’t swallow, eat or breathe on his own. He’s only 68.

“I’m hoping that the stress of the placement didn’t contribute to the stroke,” Peer said. “It’s a time when there are massive changes in a person’s life. But you trust the personnel at the home.”

While Peer wanted her brother to stay longer at Lakeshore, she said that was never presented as an option — a violation of federal law, according to Bob Daly, a manager of long-term care enforcement for the Centers for Medicare and Medicaid Services.

Though Lakeshore says it’s a short-term rehab center, it’s still licensed and registered as a skilled nursing facility. That means that Lakeshore has to provide the same type of long-term care that one would expect from a nursing home, Daly said — it has to allow people to stay there as long as they want and can afford to pay.

“They should have nursing services able to focus on people who don’t really need short-term rehab,” Daly said. “People who are older and slowly declining in their functions should be able to stay there.”

After getting a tip those services were not available, the Minnesota Department of Health investigated and found that nearly a dozen patients were discharged and sent to other nursing homes to receive care that Lakeshore should have provided. One resident was discharged from Lakeshore for being too confused, after being there for only one night. Another resident was discharged for having dementia. Another was discharged for frequently falling.

Though no actual harm came to the patients, the report noted, all those discharges violated federal law.

Officials who manage Lakeshore contend that, in the case of the violations, they did nothing wrong. In fact, they say, Lakeshore was doing what it is supposed to do: send patients who need that type of care to places better-suited to provide it.

But Daly said that as a licensed skilled nursing facility, Lakeshore has to provide services one would expect from a nursing home.

“There was no reason for this facility to discharge these residents to other facilities,” he said.

CHANGES TO BUSINESS MODEL

This was the first time Daly had heard of a case like this.

“I know that the nursing home industry in many instances is focusing on the short-term rehab patient,” he said. “But we’ve never had a case that I know of where a facility was actually discharging people because they didn’t meet that business model.”

Lakeshore is managed by the nonprofit Ecumen, one of the country’s largest nonprofit senior housing companies. Ecumen leadership stresses that Lakeshore is not set up to provide long-term care anymore. Instead, they describe their facility as a new model of care designed to get recovering patients back to their homes as soon as possible.

The services they provide are unique in the Duluth area and were developed in response to local demand, they say.

“The nursing home that used to be called Lakeshore is gone,” said Eric Schubert, Ecumen’s vice president of communications. “We don’t have a nursing home there anymore. We built a new product. It’s a short-term-care rehab center. It’s not a long-term-care center.”

Patients who aren’t making progress in rehab belong in traditional nursing home facilities, said Mick Finn, Ecumen’s vice president and chief of operations. Finn said Ecumen essentially has been forced to be licensed as a nursing home because there’s no licensure for a short-term-care center or any facility that fits their business model. In essence, they say, federal policies haven’t caught up to their product.

“We were hoping we could be accommodated in the current licensure system and it turns out that we cannot be,” Finn said. “So, you know, our bad.”

But Darcy Miner, who manages compliance monitoring for the Minnesota Department of Health, said that though Lakeshore may say it’s a short-term care facility, “it’s still certified as a skilled nursing facility.”

“As such, they need to accommodate residents who develop long-term-care needs,” Miner said. “This raises a lot of very interesting questions, to say the least.”

Lakeshore, or any other adult care center, must be certified as a skilled nursing facility if it wants to get Medicare reimbursement. Medicare will cover the cost of rehabilitation, room and board for up to 100 days. After that, patients must pay for services through private insurance, private dollars or Medicaid, which covers long-term care for those not able to afford it but doesn’t reimburse providers at as high a rate as Medicare does.

That Lakeshore is still licensed as a nursing home and has to provide long-term care is a surprise to some in the medical community who refer patients there.

“They made a public showing that they were getting rid of their long-term beds,” said Dr. Paul Sanford, an internist and chief of medicine at St. Luke’s.

Sanford said he believes Lakeshore has provided exemplary care, but he doesn’t understand why patients who need long-term care are being admitted. For them, he said, he worries they might be discharged too soon.

“It’s a real ethical issue,” he said.

Peer wonders if that’s what happened to her brother.

“If they were anxious to get rid of him — if they weren’t 100 percent sure or at least weren’t very certain that he could succeed somewhere else — and they encouraged it because they wanted wealthier people,” she said, “then I’m very distressed by that.”

CHANGING TO ADAPT

It is no secret that most traditional nursing homes across the state and the country are struggling financially. Since 2000, 50 homes have closed in the state, according to the Minnesota Health and Housing Alliance. About a third of all the state’s nursing homes are in danger of closing, according to the Long-Term Care Imperative, an advocacy group for nursing homes.

Daly, of the Centers for Medicare and Medicaid Services, said that’s why more homes have turned to short-term care models to improve revenues.

But some health-care experts speculate there might be financial incentive for Lakeshore to continue to be registered as a nursing home.

Jennifer Schultz, a health-care economist at the University of Minnesota Duluth’s Labovitz School of Business and Economics, reviewed Lakeshore’s deficiency report from the state as well as the tip letter sent to the state, which the News Tribune obtained, and felt that Lakeshore could be targeting patients in need of care that is reimbursed at higher rates.

“What I think they’re doing is they’re keeping patients as long as they need expensive rehab services that can be reimbursed at a higher rate, and then it looks like they’re transferring them to other nursing homes when they don’t need that level of skilled services and don’t get that level of reimbursement,” Schultz said. “I would say this looks suspicious and needs to be investigated.”

Still, she said, Lakeshore is doing what would be expected of a business trying to stay profitable.

“It’s an incentive setup to conduct that type of behavior,” she said. “And if it’s operating like a business, it’s maximizing revenues. You would expect them to game the system that way.”

Jill Klingner, an assistant professor of health care and operations management at the Labovitz School of Business, also reviewed the report and tipster letter and concurred with Schultz.

“They just want to keep the people that don’t need help with daily living,” she said. “They want to keep the people they can provide rehab to that they can bill additional charges for.”

A business model of this type isn’t illegal, Daly said, but patients can’t be discharged if they want to stay and can pay for it.

Lakeshore administrator Paul Libbon flatly denied that the facility is only seeking higher-reimbursing patients. The only patients they’re seeking, he said, are those seeking short-term care.

NO LONGER WILL TAKE MEDICAID

Both the state health department and Ecumen leaders said steps have been taken to ensure that similar violations don’t happen again. Ecumen now provides information to new patients that they can stay and receive extended care at the home.

But administrators still insist that Lakeshore will only provide short-term treatment. To avoid getting patients seeking long-term care, Finn said, Lakeshore will no longer accept patients on Medicaid, or patients with low incomes.

For those patients, under general reimbursement rules, that means they likely can only stay at Lakeshore for 100 days — or the amount of time Medicare will cover 100 percent of costs before Medicaid payments kick in.

To some, that poses another line of questions. Ecumen is affiliated with the Evangelical Lutheran Church in America and raised money for the center’s renovation by saying it would help provide charity care.

“Given that the community made contributions to this charitable organization, what was the community’s idea about the facility?” Klinger asked. “Did the community know this would be a high-end facility that, if you couldn’t make improvements, you’d have to go somewhere else, and they wouldn’t allow just anybody in?

“It looks ugly. It sounds ugly. It is ugly.”

The ELCA referred questions to Lutheran Services in America, which declined comment.

But Schubert said Lakeshore provides thousands of dollars in charity care.

“We’ve served a ton of low-income people that come through here for short-term rehab,” he said. “When short-term rehab is done, they can move on to places that provide people with long-term care.”

Libbon agreed, noting that Lakeshore provides home-delivered meals to 100 seniors in Duluth, provides computer training to seniors and accepts Medicaid clients at the campus’s Assisted Living facility.

“It’s about what do people want,” he said. “We are fortunate to have this in the city of Duluth.”

What do you think . . . does age matter when it comes to choosing our next President?  Post your comment below.

Here’s what a recent NBC-Wall Street Journal poll shows on the subject:  72 percent of potential voters in the poll said Americans are ready to elect an African-American and 71 percent ready for a woman as U.S. president, a smaller number — 61 percent — said fellow voters are ready to elect a candidate older than 70.  Yet Sen. John McCain is running even with both of these candidates in national polls.

Ecumen journalistic partner Kay Harvey has further analysis on this at MinnPost.com.

Policymakers across the country are wondering what to do about rising health care costs and increased needs for aging services coming from the age wave. Ecumen CEO Kathryn Roberts discusses this in the article below, which appeared on the editorial page of yesterday’s Saint Paul Pioneer Press:

Deliver the Right Care in the Right Place at the Right Time

Minnesota spent $553 million on elder care last year. If the age wave and status quo continue on parallel tracks, we’ll soon hit unsustainable budgets and intergenerational conflict.

You get a flavor for that right now as state policy-makers do their biannual budget dance with the elephant in the room — aging services.

Gov. Tim Pawlenty’s budget proposal slices more than $130 million in aging services over the next eight years, most of it from nursing homes. The Senate would delay a 2 percent cost-of-living adjustment to homecare employees, while the House would make no cuts and give nursing home workers a 2 percent pay increase. Even with a budget deficit, cuts to government-funded nursing homes aren’t the right tactic now.

Most people don’t want to live in a government-funded nursing home. But 30,000 Minnesotans rely on their care. Because nursing home care is mostly paid for by government dollars that don’t cover the costs of care, many nursing homes have less than 10 days’ cash on hand. Choosing between payroll and innovation isn’t a choice. The silver tsunami requires transformative thinking, not shortcuts to a dead end.

Most people don’t need “long-term” care and million-dollar nursing home stays. But serious disconnects in our patchwork health system often lead to institutionalizing people, over-doctoring, draining will and devouring public dollars.

In a coordinated, localized short-term care system, people would move much more
easily and with greater confidence from the hospital to coordinated care and services. A nursing home would be a specialized medical respite center for rehabilitation and chronic care management, not an underfunded institution where someone recovering from a hip replacement shares a wing with an Alzheimer’s patient. It also wouldn’t have the overhead of hospitals’ emergency services, surgery suites and birthing centers. And it would pay providers based on the value we bring to the person and to coordinated health care.

This is all about delivering the right care in the right place at the right time. If you’re not at the hospital or respite center, you’re in your own home or an assisted living facility served by professionals. A coordinated short-term care system is also predicated on not turning assisted living into a mega-regulated nursing home that thwarts independence and suffocates people’s willpower.

In a paradigm-shifted approach, the respite center could be the medical home for chronic and elder care — the technologically connected hub that coordinates all therapy and services among settings.

That future is emerging in Duluth, where we’ve replaced an outdated nursing home with a short-term care center and independent, assisted-living and memory-care apartments. The focus is on getting people better so they can go home. If they need more care, it’s coordinated at an Ecumen-managed nursing home. Of 700 people we served last year at the short-term care center, only 30 went to the nursing home.

A short-term, coordinated care system would be efficient and proactive. And it would lead with self-empowerment, which today too often gets compromised.

Other states recognize this. In Oregon, you would spend less time in a government-funded nursing home than would nursing-home residents of any other state. Why? Oregon puts the biggest percentage of government dollars toward self-directed home care rather than institutional care.

Why can’t Minnesota seniors who qualify for government-paid care self-direct that care at home? They can, but few people know about the state’s initiative called Consumer Directed Community Supports. In fact, it has only about 400 enrollees. Many of the thousands eligible will likely have more expensive nursing home stays in today’s mouse-in-the-maze health system.

Minnesota had 69,000 seniors in 1950. We’re now approaching a million, many of whom will need some physical assistance. In the short term, we must forge a long-term strategy for growing old in Minnesota, not keep taking short cuts to a dead end.

Kathryn Roberts is president and CEO of Shoreview-based Ecumen, Minnesota’s largest nonprofit senior housing and aging services company. She was recently appointed to the Minnesota Veterans Health Care Advisory Council.

Can you spare a minute, and respond to this post (just click on comments below to respond)?  We want your thoughts.

You might have seen this in the news. 

Angie’s List — which has 600,000 members nationwide — built its business by providing a forum for its customers to rate painters, roofers and other service providers. Now, the company allows members to log on to www.angieslist.com to share their real-life experiences with local doctors, from the cleanliness of waiting rooms to the physician’s bedside manner.  It’s the latest sign that “consumerism” is becoming a driving force in health care.

Aging services is all about people.  It seems that creating an online forum for customers to share good reviews and bad reviews about assisted living, home care, etc., is an idea whose time has come - probably yesterday.  Yes, you’d likely get some mean people who abuse it, but it seems that a moderator could screen those types of situations.  You’d also likely get insights that need correction and attention.  Also, when someone has something good to say, others would see it in that person’s very real words.  That’s better than any type of advertising could be.  It also could be a very helpful tool for people navigating the mouse-in-the-maze health care and aging services systems.

 What do you think?  What am I missing?  Other ideas?