Aging in place striking a delicate balance.

In the first part of this two-part series, readers were given six tough questions to consider regarding assistance in living (AIL). The first part defined the aging-in-place phenomenon and described the challenges it presents to facilities. In this part we will address some possible solutions to this serious dilemma.

Senior housing sponsors have an obligation to provide appropriate, cost-effective assistance with activities of daily living (ADLs) for their residents. But besides the satisfaction of knowing you're doing the right thing, there could be other significant payoffs for those who do it effectively.

For instance, communities offering either full or modified life care contracts could lower their health care benefit costs by substituting formal assisted living (AL) or (hopefully) temporary assistance-in-living (AIL) services for higher-cost nursing home admissions, where applicable.

If you were concerned that your prospects appeared dim after answering the questions from Part I of this series, there is hope. Consider adding an integrated but separated AIL neighborhood within the independent living (IL)section of your campus.

With less personal living area and more services compared to the typical IL community, an AL section is frequently the most cost-effective way to deliver optimum service to your residents for a reasonable, affordable price. This can also be accomplished through purpose-built new design or by converting existing space.

The separated/integrated neighborhood concept might seem like an oxymoron, but it can be done and appear seamless.

Consider this brief concept overview:

1. Create two separate residential neighborhoods (IL and AL) connected and integrated under the same roof);

2. Utilize a common core area including commercial kitchen, laundry, maintenance, etc.;

3. Provide separate satellite dining rooms for each living arrangement supported by the common commercial kitchen (like many hotels offer);

4. Offer properly sized and separated public spaces (lounges, etc.) for each living arrangement.

This purpose-built approach is what designers use today for a new community that plans to offer both IL and AL. But what about an older property's conversion needs?

A typical IL-to-AL conversion example might look like this: One or two independent floors (or wings) become designated for AL. Small satellite dining rooms are created within either existing space. Food from the main kitchen is delivered to a satellite warming kitchen where food is plated for AL residents.

This conversion will likely require the gutting of several revenue-producing IL units to provide the appropriate space. You might also consider creating an Alzheimer's/dementia carve-out wing--providing a secure courtyard if the conversion is on the ground floor.

But before deciding which strategy is right for you, ask yourself three key planning questions:

1. What is likely to be my least costly way of serving residents' varying and growing needs for assistance with activities of daily living? For the most realistic response, make a detailed cost comparison between providing a dedicated AL section versus delivering assistance with ADLs randomly distributed within your IL units.

Consider the likely impacts on cost and your resident profile now as well as five, seven, and 10 years into the future. Remember, the most attractive short-run option may not always be the best long-run strategy. Look at several scenarios, such as providing ADLs for 10 percent of IL residents now versus the likelihood of that need growing to more than 50 percent in several years.

2. How will three very important, senior consumer groups and their adult children feel about the strategy you're about to adopt? These three groups are your existing IL residents who need assistance with ADLs; residents who are still relatively healthy; and potential new residents. The obvious challenge is finding a service delivery system that will satisfy the first group without driving away the other two.

3. Will your IL residents actually move to the appropriate purpose-built AL arrangement at the appropriate time? Despite the best of intentions, a multi-level, full-service senior living community can experience mediocre performance because of resident noncompliance. To help ensure that residents are willing to move when the time comes, you must initially develop very specific IL resident admission and discharge policies--and they must be tactfully, yet consistently, enforced.

Pricing strategies 

If you plan to charge an extra fee for AIL--added to your IL monthly service fee--it should be driven by the loaded cost of your direct care staff. Look at figure 1 for a pragmatic approach to determining the right pricing model. Figure 2 provides seven key strategies to consider when dealing with the aging in place challenge.

[FIGURE 1 OMITTED]

FIGURE 2

THE TOP SEVEN STRATEGIES FOR
DEALING WITH AGING IN PLACE

These seven strategies are imperative when dealing with the aging in
place issue:

1. Deal with the problem now, because it will surely intensify,
   rather than diminish, with time.

2. Resist simplistic "politically correct" approaches that
   accommodate individual independent living residents in the
   short run, but create extensive community problems in the
   long term.

3. Clearly define the circumstances under which a resident
   must move to another living arrangement--using your
   Residency Agreement and, where appropriate, Negotiated
   Risk contracts.

4. Clearly communicate policies, procedures, and admission
   criteria to new residents and their families.

5. Get your resident leadership involved in the acceptance of
   this difficult, but necessary, policy-making process. This
   helps your residents feel they are part of a positive
   solution, rather than representing a major problem within
   your community.

6. Closely monitor each resident's health status on a
   continuing basis.

7. If you operate an older community, consider developing a
   second-generation (new) independent living section or
   building that will replace the existing one as aging
   residents gradually (and inevitably) convert the initial
   community into a "Naturally Occurring Assisted Living
   Community."

Whichever route you follow, you must adopt certain strategies now in
order to effectively plan for the future

Moving your IL residents through your continuum will continue to present significant challenges. These could be further complicated by two initiatives currently in play: Fair Housing and Americans With Disabilities Act (ADA). It may be called aging-in-place, but there's little that's static about it.