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In the Long Run
The evolving face of long-term care in Connecticut
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Business New Haven
6/14/99
By: BNH
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The past decade has seen a sea-change in long-term care in Connecticut. As the population continues to age, and as seniors and their relatives search for options, they're finding a growing number of alternatives.
Due to changing demographics and the precipitous growth of the 55-plus age group, seniors can take advantage of a burgeoning variety of health-care and residential choices, says Cindy Holle, regional director of marketing and managed care for the Boston-based Harborside Healthcare Corp., which owns skilled nursing facilities across the U.S.
In December 1997, Harborside purchased Arden House in Hamden, the Willows in Woodbridge and Madison House in Madison from Connecticut Health Care Facilities.
In New Haven, the long-term care continuum stretches from living independently at one's own residence to hiring in-house home-health aides to spending part of the day at adult day care to moving to a facility that offers limited support services, such as an assisted living facility (ALF) or continuing-care retirement community (CCRC), to using a skilled nursing home for short- or long-term care.
"Each person or couple has first to decide where they fall on this continuum and then which specific facility or facilities will best answer their needs," Holle recommends.
Holle explains that seniors - or their baby-boomer children - who inquire about Harborside's skilled nursing operations are "very open to letting you know their wishes and wants. Consumers are increasingly educating themselves on which services are available and what is best for their immediate and long-term needs."
And these requirements encompass both medical and residential. "Potential residents naturally want the highest quality health care," Holle says. And amenities are becoming critical in the decision-making process as well. Harborside, for example, offers such features as fine dining and private dining rooms, as well as a range of recreational activities and libraries.
Assisted living facilities (ALFs), the senior living option that has recently boomed statewide and beyond, are the outgrowth of this need for more choices.
"Retirement communities for people over 55 started being built in Connecticut about 20 years ago," explains Ethel Chorney, residential consultant at Gardenside Terrace, an ALF slated to open in August. However, these senior developments lacked support services or medical care. So "You started seeing the first hybrids, like senior apartment complexes, that would bring in services such as a dining room, housekeeping, linen, recreation and transportation," she says.
The first facilities actually designed for assisted living began to open in 1997. These offer assistance with daily living activities and either hire professional staff such as nurses and certified nursing assistants or contract with a home-care agency.
Gardenside, for example, will offer a range of services for a monthly fee starting at $1,995 for a studio apartment and have both support staff and nursing available - for an extra cost.
"The goal is allowing people to be independent as long as possible," adds Chorney. "Assisted living lets residents be on their own until they become too mentally or physically frail and need 24-hour care in a skilled nursing home."
Owner Charles Shelton is building Gardenside on the 19 acres next to his 20-year-old nursing facility, Branford Hills Health Care Center, which offers skilled nursing care, short-term rehabilitation and outpatient therapy.
The two are a logical link, he says, giving people uninterrupted care throughout their senior years.
Michael Zaccaro, chief operating officer of CareMatrix, notes that several factors have led to the growth of assisted living care. Based in Needham, Mass., CareMatrix today operates ALFs owned by David Reis in Avon, Hamden, Milford and Woodbridge (a fifth facility is under construction in Orange).
"In 1991, the state put a moratorium on nursing homes until 2002," Zaccaro notes. "Meanwhile, the elderly population in Connecticut has continued to grow: Those over the age of 75 are increasing by two to three percent a year - and over 85 even faster."
To keep pace, the number of assisted-living units in Connecticut has grown fivefold over the last five years-1,200 to 6,000, including those now under construction. But does demand warrant the supply - even with the rising elderly population?
"Three years ago, when health-care companies developed their future plans, no one imagined so many would get into this assisted living market," notes Zaccaro. "The astute organizations-the ones surviving in the long run-will be those that understand the true cost of business. The cost is not just in bricks and mortar, but also in the time needed to build occupancy."
Given that growing need, these facilities will eventually be filled, but it will take much longer than some have projected. It is probable that some facilities won't be prepared to make the wait.
Some believe that the monthly fee - which is relatively flat from one ALF to another because of comparable overhead costs - may discourage those who are in any event ready to make a transition from their own homes. Zaccaro believes, however, that the charges need not be an insurmountable obstacle for most people.
"In Connecticut, 60 percent of seniors have an income over $30,000, and 80 percent of them own their own home," explains Zaccaro. "The reality is that assisted living is do-able for a large number of these people."
Add to this the fact that the majority of seniors stay independent late into their lives: Most ALF residents are in their low 80s.
Lower-income seniors have long had an option for residential care home - historically it was known as "the home for the aged."
They endure. Although these facilities are, like ALFs, designed to provide support services, they are typically smaller and more communal oriented. Unlike ALFs, residents can receive state funding.
The133-year-old Mary Wade Home, a New Haven not-for-profit, offers a 45-bed residential care home. Some 80 percent of residents receive a state subsidy, says David Hunter, Mary Wade's CEO. Mary Wade also houses a 60-bed skilled nursing center for 24-hour care, an adult day health center and outpatient rehabilitation clinic.
Hunter, who regularly sees people whose income cannot support the monthly rates at ALFs or buy-in costs at retirement communities, notes that the state legislature has approved a bill for a study on subsidized support for assisted living. It remains to be seen, however, whether such funding will materialize.
"Assisted living is such a new arrival in Connecticut," says Hunter. "A lot of questions still remain unanswered. However, we do know that seniors - and a growing number of them especially living only on Social Security - will need alternatives that address the quality of life in long-term care."
Martin Sbriglio, CEO of Ryder's Health Management, a 50-year-old, family-owned nursing home business with facilities in Stratford, Waterbury, Newington, Chester and Waterford, has many questions about assisted living. The biggest one: Why the big difference in regulations between "skilled nursing" and "assisted living" facilities?
Changes in state, and especially federal, regulations as well as in reimbursement systems now necessitate at least four hours of paperwork for each person being admitted to one of his nursing homes, Sbriglio notes.
"The government made these changes to keep costs down and improve the quality of care," he explains. "[But] it has done just the opposite. That's why so many nursing homes are going bust: They can't afford the increased staff and resources needed - not to take care of the patients, but to do the paperwork."
The state's Assisted Living Service Agency, he says, regulates only the medical services the ALF provides. In contrast to a nursing home, it does not license the facility itself; this makes for a major discrepancy between the amount of red tape required for each.
Sbriglio stresses that he is not against regulations per se: "Over the years my family has been a strong supporter of patient advocacy," he says. Rather, it's the excessive amount.
"Somewhere there has to be a happy medium between what's required for ALFs versus for skilled nursing facilities," he says.
Although Ryder's has its own permit for an ALF in Stratford, the organization hesitates to move the bulldozers. Sbriglio cites the glut of facilities in his service area, and say he fears that it may only be a matter of time before ALFs will, like nursing homes, be inundated with regulations.
Sbriglio stresses that consumers have to assume a large measure of responsibility on the long-term care issue. They must recognize how changes in regulation impact the cost of running a health-care facility, and advise their government representatives to find ways to reduce escalating costs.
And consumers need to realize that there's good and bad in any industry, including long-term care - especially with so many new places opening.
"When choosing a facility, people have to do their homework and look beyond the building décor and landscaping," says Sbriglio. "They have to be sure that this new home meets their specific health-care, social and residential needs."
Securing one's future is a need that the 20-year-old, not-for-profit Whitney Center in Hamden fulfills for its 250 residents, according to Lisa Giller, its president.
As with most CCRCs, residents who live independently in their Whitney Center apartments pay an entry fee that "insures health-care costs will be covered in the future," she explains. In addition, the monthly service fee does not increase when medical care - short- or long-term skilled nursing - is required in the adjoining Whitney Center Health Center.
"We were one of the first CCRCs in New Haven and continue to be successful today with nearly 100-percent occupancy," says Giller. To remain competitive, Whitney Center has continually updated services, including receiving the state's first ALF license.
Whitney Center also encourages pets-in-residence and has provided a growing number of amenities such as a café, convenience store, fitness center and bank. It also added a computer center, since many residents enjoy plying the Internet and exchanging e-mail.
The relationship between her facility and its residents is what differentiates the senior communities of Cedar Crest and Cedar Woods in Branford, says Alina Szczerbicka, Cedar Crest's manager. The two operations are owned by the Holiday Retirement Corp. of Salem, Ore.
Cedar Crest offers studio apartments and Cedar Woods one- and two-bedroom units along with meals, transportation, housekeeping, laundry services and a weekly visiting nurse clinic, for a monthly fee.
Both facilities are fully occupied and have a waiting list.
"With only 21 apartments at Cedar Crest, the staff spends a lot of close, quality time with the residents. There's never too little time for a hug or a warm conversation," explains Szczerbicka.
Although not licensed as an ALF that provides some medical support, the personnel get to know the residents so well that "We can anticipate when someone may need additional care," Szczerbicka. "We then help them and their families either bring in outside assistance or, if necessary, go to a skilled nursing or rehabilitation facility. Our goal is to keep everyone independent and happy."
And the two definitely go hand-in-hand, she stresses.
"The residents' personal treatment and lifestyle is our No. 1 priority," she says. "Their happiness reflects on their physical health and keeps them on their own for as long as possible."
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