Merry Christmas

While it may seem like we have had a poor performance year within our Seniorsfirst Communities and there has been a lot of talk about a weak economy or declining resources, 2009 hasn’t been all doom and gloom. Sure, there are plenty of needs and wants still on my “Christmas list” for Seniorsfirst:

1) A rebased Medicaid rate for Kirkhaven retroactive to April 1, 2009

2) A couple of more Entrance Fee move-ins for Valley Manor

3) An 8 million dollar grant to help fund our Kirkhaven Replacement Project plan

4) 92% occupancy at Valley Manor

5) Additional revenue to enable us to give staff pay increases

But, there have also been some very nice gifts received this year that we don’t want to lose sight of and are very grateful for:

1) Occupancy at Valley Manor has improved from 83% to 89.5%
2) Occupancy at Kirkhaven has remained high at 95%
3) Staff turnover has been consistently low
4) Customer satisfaction has been consistently high
5) Employee satisfaction has remained consistently high

With a New Year only days away, our hope is for a brighter future despite the challenges that the economy presents. We know that the State’s budget woes create a concern for our Medicaid reimbursement at Kirkhaven and that a tough economy means we have to work even harder for new move-ins at Valley Manor. But we also know that our service and staff are among the best and thus customers will always beat a path to our doors looking for only the best.

The tough economy will continue to challenge us, but together we will take the necessary steps to ensure an operation where revenues are in balance with our expenses and our hallmark quality is always maintained. We will continue to wish for a Merry Christmas and a Happy New Year, but will be grateful for whatever gifts are bestowed upon our organization. In the end it is the relationships we have and how we work together that counts the most. Every great organization faces adversity, setbacks and change- it’s how an organization reacts and uses the gifts it has, that is the key.

Over the years, I’ve seen this played out over and over again. I have every confidence that our great Seniorsfirst organization will navigate through these rough times and even flourish in the days ahead. So let’s keep our heads held high, our nose to the grindstone and give thanks to God for the gifts in our lives.

Happy Holidays to all! Here are a few pictures with me playing Santa with Kirkhaven residents:

Jim DeVoe, President/CEO

Albany Acts- But Call Me Scrooge!

The State Legislature and Governor finally reached an agreement on a deficit reduction plan for fiscal year 2009/10. The news is good (at this point in time), but call me Scrooge as I will hold off any personal celebration until a few more unknowns come to pass. First the good news:

• Yes, most of the proposed deficit reduction plan items (10% and 3.7% rate cuts, delay in implementing the 2009 rebasing rate and 2010 regional pricing rate, .5% cash receipt assessment increase) were rejected. These items were included in our Kirkhaven "worse case" scenario Medicaid rate projection for 2010 (Medicaid estimated rate of $155.30). Therefore, our moderate or even best case scenario Medicaid rate for 2010 ($163-171) are "back in play".

• Yes, with the 2009 Medicaid rebasing rate still in law, we should expect to receive a revised 2009 rate retroactive to April 1, 2009.

Now the reality check where I play the part of Scrooge:

• We still have no further guidance on when the April 2009 rate will be paid and what the rate will actually be. This is a continuation of the issue that has plagued us all year long. We have rate methodology estimates that suggest the rate will be good for us ($171/day versus the $155.30 currently paid), but it is an estimate at best and we can't keep paying out expenses at our current level while we only receive the deflated $155 rate. Cash flow is an issue and we still may need to take immediate action to level our cash flows despite the expectation of a retroactive Medicaid payment of approximately $300,000 for 2009.

• We still have no further guidance on the April 2010 Regional Pricing Medicaid rate or methodology. This is also a continuation of the issue that plagued us with the development of a meaningful 2010 budget. We have estimates that suggest that Regional Pricing could be good for us, but it is very subjective and based on limited actual data or facts. While our moderate and best case scenario budget projections appear more viable based on the recent action by the legislature, we are still in the same waiting game as before and until actual rates are issued and paid, we have an operating challenge to meet cash flow needs in the interim.

• By the Governor's own admission, the action by the Legislature still falls short of meeting the State's needs. Therefore, we can expect more of the same with respect to delays and threats to our future Medicaid rates. We just seem to be always treading water and never seem to find dry land where we can finally move on.

With respect to what the Legislature did pass:

1. The elimination of the 1.7% Medicaid trend factor for the first quarter of 2010 obviously removes cash from our future operation, but does not impact our 2010 Medicaid rate projections as we had the foresight not to include a trend factor in our rate projections.
2. The HEAL-NY payment delays has no operational impact for us, but does send us a message that the likelihood of future HEAL-NY grant opportunities is probably non-existent until 2011 at best. This certainly impacts the timing of our KH Replacement Project, which is contingent upon HEAL funding.
3. Increase in Fraud & Abuse recoveries has no immediate impact on our operational budget but does send a scary message that we can expect more scrutiny and audit recoveries from not just blatant acts of fraud (of which we support), but money grabbing schemes aimed at innocent and outrageous documentation and procedural omissions.

In short, the news is good compared to what was on the table, but many of the critical question marks related to our 2009 and 2010 rates and HEAL-NY funding access for the KH Replacement Project continue to remain unknowns. The continued delay by the State to address these will have the impact of our needing to implement a deficit reduction plan of our own at Kirkhaven in order to meet cash flow requirements. I'll keep you apprised of any further developments. Happy Holidays!

Dear Albany: Just do it!

Hockey legend and the NHL's all-time scoring record holder Wayne Gretsky once said, "you miss 100% of the shots you don't take". Likewise, it is the wise baseball coach who tells his younger players, "if you're going to strike out, at least go down swinging".

So please, Albany, enough already with the stagnation, inaction and waffling. While you sit on your hands trying to figure out what to do to make things work, the rest of us are left trying to figure out how to do our work with what you're not doing. And what you're not doing is:

• establishing a definitive strategic vision
• creating an effective & efficient plan to arrive at that vision
• implementing a plan
• staying the course

Instead all we have gotten out of Albany is:

• an unfulfilled "promise" to finally re-base our 1983 base-year Medicaid rates to a more fair and current 2005 base-year in 2009
• a stall tactic that as of yet has not produced or paid us this promised revised Medicaid rate
• a "temporary" reduction in our Medicaid rate while Albany is "working out" the implementation plan details of a new Medicaid rate
• a "sudden" change of plans when Albany unilaterally came up with a new Medicaid Regional Pricing idea
• a lack of clarity on what our final 2009 & 2010 Medicaid rates will look like or when they will be paid

In the interim, we are left in the dark while continuing to care for the elders of your State for whom you pledged to represent and serve. Your failure to pay us what you promised has left us with deficits and debts that we must now recover from. Your lack of clarity makes it impossible for us to make informed decisions or long-term strategies. Your inaction leaves us helpless in our attempt to rationalize what action we need to take.

So please, Albany, get your act together and just do it! Better that we at least know where we stand, so we can plan for where we need to move. But don't take back what you already promised and don't look backwards at what already has passed. It's unfair and unconscionable to expect us to absorb or plan for reductions retroactively enacted. Look forward, establish a vision, create and implement a manageable plan, and stick to it.

If you can at least give us a clear and reachable target to aim for, we might stand a chance to hit it. If you can at least tell us where our final destination is, we can hopefully set a course to get there. If you can at least provide us with a rule book, we can try to play the game. But please, Albany, give us something and just do it!

A Busy Week of Activities

My week began with a scheduled visit by U.S. Senator Chuck Schumer to Valley Manor where he held a press conference to announce his sponsorship of the National Silver Alert Act. Anytime the Senator comes to town, it is a big deal for Rochester. To have him come to Valley Manor, is a big deal for Seniorsfirst. A big "thank you" to board member Sharon Boyd (president/CEO of the Rochester Alzheimer's Association) for referring this opportunity to Valley Manor.

The Silver Alert Act is modeled after the AMBER Alert and will provide federal coordination and assistance to local and state enforcement to assist efforts to locate missing senior citizens across the country. The Senator's visit brought out all the media and a room full of Valley Manor Residents and community supporters. Not surprisingly, once the Senator finished his prepared statements, the conversation turned to the issue of national health insurance.

On Tuesday, I had the excitement of attending the state auction of the Armory site (see earlier Blog entry). That turned out to be more drama than I had anticipated and was certainly an interesting experience.

On Wednesday and Thursday we held our Kirkhaven and Valley Manor board meetings. At both communities we had a strong focus on financial performance and fiscal strategies as we reviewed our 3rd quarter statements and prepared for our 2010 budget development. I wish I could say all is well, but in these challenging economical times, I'm not sure that is even a reasonable expectation. We'll be putting together a contingency plan to ensure we are prepared to handle whatever comes our way. I'll Blog on that subject in the weeks to come.

On Friday, I attended the Greater Rochester Awards luncheon, which celebrates the exceptional work accomplished through our community's human services sector. Congratulations to Seniorsfirst board member, Pat Grover from the National Multiple Sclerosis Society, who was honored with a Community Champion award.

On Friday afternoon, I volunteered to perform for the Kirkhaven residents at their weekly Happy Hour. I had a blast playing and singing Halloween songs to mark the occasion. When I ran out of Halloween music, I played some of my country music and other favorites. I wasn't really surprised that they enjoyed singing along with "Amazing Grace" and "America the Beautiful", but who knew they would have so much fun with Neil Diamond's "Sweet Caroline".

Lastly, here are two cute pictures from a little pre-Halloween activity my wife and I had with our grandsons Logan and Brennan.

Thanks for visiting my Blog. See you next time!

A Day at the Auction- Going Once, Going Twice..........?

As many of you know, Kirkhaven has been actively working with local Real Estate Developer, Larry Glazer and Buckingham Properties on a potential Kirkhaven Replacement project on the site of the former Armory on Culver Road across from Cobbs Hill Park. The site is owned by the State of New York and earlier this week the State put the site up for public auction. I have never attended such an event, but since Kirkhaven had a keen interest in the outcome of the auction, I went to observe the action. I had no idea I was in for such high drama worthy of a Blog posting.

At exactly 1 p.m. Tuesday afternoon, I walked into the Ebenezer Watts Conference Center where the auction was scheduled to take place. The room was packed, standing room only in the back and every news station and media lined up along the side wall with cameras and microphones at the ready. I sat down in the seat saved for me along with the Buckingham Properties team. The State auctioneer began his prepared statements and "rules of engagement" as I measured up the competition. A full house didn't set well with me and for the first time I began to think this might not go down the way we hoped.

It was about a year ago when Larry and I first spoke about the Kirkhaven Replacement project. Larry is one of the biggest local real estate developers and he took an immediate interest in our project. Over the next several months we would periodically touch base about properties he owned, but then he called me to say he had the "perfect site for us". He was talking with the City of Rochester about the old Armory site and attempting to pull together a 3-way deal to gain site control. In the final analysis, the decision was made to forgo a deal through the City and instead let the property go to public auction where we might pick it up at a better deal. The site has an ideal location, but some environmental issues that although our project could work around, other projects could not without substantial cost.

Larry and I spoke a few days prior to the auction to discuss a maximum bid price strategy that we thought the project could support. Since Buckingham Properties would be the bidder and potential property owner, Kirkhaven was only an interested party in a potential lease deal on the eventual developed property. All the risk and decision making were in the hands of Buckingham Properties, but this was nothing new to Larry.

I arrived at the auction site at 12:30, spoke to a State representative and learned there were several registered bidders. I also learned that 2 other auctions for armories in other parts of the State had been woefully attended and sold for nearly nothing. That was encouraging news. The room was pretty empty, but I also discovered the auction wouldn't start until 1:00, so I opted to take a walk. I picked up a burger and coke from the street vendor at Court and Main and sat outside the conference center eating and sizing up the folks who began to enter the building.

When the auctioneer finished his introductory remarks he then informed everyone that the bidding would begin at $500,000 and move up in $20,000 increments at first and then $10,000 or $5,000. Bidder #1 boldly opened the bidding at $500,000. A few others threw out competitive bids, but bidder # 1 quickly countered every bid with a brash and arguably erratic higher bid each time. In no time at all, the bidding passed the $750,000 mark and the bidding slowed down. I was intrigued by bidder #1, although I could only see the back of his head. He sounded like a kid and wore a Buffalo Sabres cap and cut off sweat-shirt. I whispered to the "suits" on either side of me, "who is this guy," but neither knew. As the auctioneer shouted going once, going twice............suddenly a suit from the other side of the room threw out his first bid and the game was on. Bidder # 1 and Bidder # 8 went back and forth and back and forth. The kid rarely paused as he threw out his cocky bid retorts, the suits took their time as everyone waited in anticipation. Was this it, was it over? But each time the suits raised the bid.

Then Larry jumped in with a bid at $900,000. My blood began to run faster. "Okay", I thought, "Larry's in the game and this might get really interesting now". The suits and bidder #1 kept raising it higher and Larry jumped in again at just over a million dollars, but the bid went higher yet and Larry put his card away. The bidding had gone beyond our intended limit and now the only drama that remained was would the kid in the Sabres cap out last the suits.

The whole process took about 20 minutes and every minute was intense. With each bid, the cameras would shift their attention to the other bidder and the room would wait. You could cut the tension with a knife and when a counter bid was finally shouted out, the room would take a breath and shift its collective attention to the other bidder. And so it went until the suits put out a bid of just under 1.5 million and the kid laid down his card. Going once, going twice...........SOLD!

The winning bidder was another local real estate developer who would later explain that he has no known plans for the site, but couldn't pass up the opportunity for such a great piece of real estate. We'll talk to him about our plans, but that is a long shot given the high price he paid for the site. The "kid" wasn't as young as I had thought and turned out to be a partner in a local group that wanted to turn the Armory into some type of sporting venue for the neighborhood.

I am disappointed that yet another option for our Kirkhaven Replacement project has appeared to have hit a dead end, but for every door that closes, another door opens up. We'll keep on searching and talking and something will eventually come along. Maybe something with less drama and a happier ending. Larry Glazer has already indicated to me that he has another possible venue for us to explore, so let the games continue and keep the faith!

Judging the Judge

Most voters don't know a lot about the candidates that run for Judge and thus either don't bother to cast a vote or cast a vote simply on party lines or name recognition alone. Since my wife Jennifer works as the Law Clerk for a sitting judge up for election this November, I have become more attuned to the judge race and thought my Blog readers might be interested in an "inside" perspective that represents my opinion only.

Depending on what Town you live in, there are probably many candidates vying for a local town or City judge seat. The advertising and array of lawn signs can be very confusing at best. But if you live in Monroe County, everyone will see on the ballot an opportunity to elect to keep Judge Brain McCarthy on the Monroe County Court bench. Here are a few basic reasons why Judge McCarthy should receive your vote and then I'll share with you the inside reasons:

• 3 decades of experience as a Prosecutor in the Monroe County DA's Office and the U.S. Attorney's Office.


• B.A. from St. John's Fisher College and Law Degree from Syracuse University.


• Respected and supported by his peer judges on the bench and most every law enforcement agency within Monroe County.


• A stellar track-record in the court room based on fairness, integrity, justice and results.

A judge doesn't impact your taxes, develop budgets for spending of public funds or create legislation that affects your life, so why should you care about voting for a judge? Simply stated, a judge ensures that justice is attained in the court of law. A judge helps to keep our communities safe and law abiding. A judge ensures a fair and just trial for the accused and the victims of crime. In choosing a judge, one should focus on experience, integrity and knowledge of the law.

I have had the privilege of getting to know Judge McCarthy and I can share with you that what impresses me the most is his integrity. Experience and knowledge can be attained by almost anyone and Judge McCarthy's career exceeds expectation and need, but integrity is what separates him from others. He is a kind and gentle person who truly cares about people and justice. He is not political, arrogant or self-serving. He is tough on crime, but fair and honest in seeking justice. His personality traits are exactly what we want in a judge serving this County.

His opponent (John DeMarco), claims in his advertising to be: experienced, respected and trusted. Here is my perspective. His experience is limited to town court only. Only one law enforcement agency has publicly endorsed DeMarco-the Jail Deputies Union. Every other law enforcement agency which has endorsed a candidate for Monroe County Court Judge, including Rochester Police Locust Club and Monroe County Police Benevolence Association, endorse McCarthy. Insiders know who to respect and trust. A recent D & C news article (October 17th) reported on several former town court rulings by DeMarco that were controversial and soft on DWI and arguably legally off-base. The Rochester Against Intoxicated Driving organization has claimed DeMarco is "soft on accountability".

So, on election day, despite what frustration, anger or objective you might have as you go to the polls to cast your vote for our elected officials, please consider that the role of a Monroe County Judge is entirely different from most public officials and we need to keep good judges serving our community. From an inside perspective, the candidate who is truly experienced, respected and trusted is Monroe County Court Judge Brian McCarthy.

Keep Judge McCarthy for Monroe County Court

Lobsters Supporting Seniorsfirst Alzheimers' Programs

We recently held our annual lobster bisque fundraiser to help raise funds to support the Alzheimer's programs at Seniorsfirst. It was a long (and sometimes cold and rainy) day, but our goal was to sell off our inventory and we came fairly close.



For those who are less familiar with this annual event, several years ago we purchased the former Dickens' restaurant (located next door to Valley Manor) and eventually renovated it into what is now our Seniorsfirst Adult Day Program. As part of the purchase, we also received the "secret" recipe to the Dickens' famous lobster bisque soup, which we now have canned and sell as a fundraiser. It never ceases to amaze me the number of people who yearn for another taste of this infamous soup and eagerly await our annual community event.

This year we set up 4 convenient drive-thru sites across the greater Rochester area and introduced new "soup stimulus" pricing on our popular 6-pack and case purchases. In total we sold just over 1600 cans of soup (slightly more than last year) and grossed approximately $12,000 in sales.

The challenging economy continues to impact fundraisers like ours as we have seen a dip in sales the past 2 years compared to the record volume of previous years, but the demand appears to still be there. Our soup makes a unique Christmas present and is always a special treat for holiday dinner guests. We only have a limited number of cases left, but will continue to sell the bisque on-line at http://www.seniorsfirstonline.com/.

In addition to supporting the Alzheimer's programs at Seniorsfirst, your purchase qualifies as a tax-deductible donation. Good soup for a Great cause!

Pictures along the Pathways Journey

At both Kirkhaven and Valley Manor we are pioneers in a culture change movement that has us on a journey towards revolutionizing how we serve our elders. Our mission is to eliminate the 3 plagues that account for the bulk of suffering among our elders in skilled nursing and assisted living homes.


The antidote to the 3 plagues of loneliness, helplessness and boredom are:

• Loving & meaningful companionship and a life that revolves around relationships in a truly human community that includes children, plants and animals.


• A community that balances both the ability to give care to others and to receive care gracefully.


• A life with variety, spontaneity and choice.

A picture tells a thousand words, so here are a few that illustrate how we are living the pathway journey:

The first 2 pictures are from a special breakfast buffet, prepared by all the 5th floor household staff, for the residents who live in our dementia care household at Kirkhaven. Residents (and staff) love the variety and fun of something different and unexpected.

These next photos were taken at a fall clean-up and gardening event to prepare the Assisted Living cottage patio for the coming of winter. Residents loved the opportunity and responsibility of caring for their home.

Thanks for visiting my Blog and joining us on our Pathways journey!

A Journey to "Oz""

Last month I traveled to Kansas to visit a very special place that has a national reputation as one of the most advanced culture change organizations in providing care to our elders. This trip enabled me to witness first-hand the amazing opportunities and potential that exist within our imagination and capabilities.

The fact that we were in Kansas, the home of the infamous story of "The Wonderful Wizard of Oz", got me to thinking of the similarities between the story of Dorothy's journey and that of our own journey. And thus, I have penned this short story entitled........A Journey to "Oz".

Amanda Gale is a young, professional nursing home administrator who helps care for several chronically ill elders. One day her office, with Amanda sitting at her desk, is caught up in a whirlwind of regulatory redtape, reimbursement cuts and staffing shortages that whisk her off to a far away land named Oz. When she lands, her desk falls on and kills the wicked health department director of the East.

Glinda, the good doctor of the North, comes with the elders of Oz to greet Amanda (and her little dog Yoshi) and gives Amanda the silver pen that the wicked health department director had in his pocket when he was killed. In order to return to Rochester, Glinda tells Amanda that she will have to travel to the "Golden City" and ask the Healthcare Czar of Oz to help her.

On her way along the "pathway to meaningful living", Amanda meets a lonely old lady who she talks to and befriends, a helpless old man who she seeks assistance from, and a bored old woman who she invites to join their party. All are convinced by Amanda that the great Czar can help them too. Together, they overcome obstacles along the pathway to the Golden City including regulatory requirements, a lack of funding and the deadly naysayers to change.

When the travelers finally arrive at the Golden City, the great Healthcare Czar agrees to help them, but first they must kill the 3 plagues of elders- lonliness, helplessness and boredom, which account for the bulk of suffering among the elders of Oz.

As the friends travel across the land of Oz, the 3 plagues attack them and all the others elders of Oz. Everywhere they go, the elders appear to be lacking meaningful living in the places where they live and are cared for. Amanda is not detered and uses her silver pen to craft new ideas and a vision for a better world in a land free of the 3 plagues.

When the wicked health department director of the West snatches the silver pen from Amanda by trickery, Amanda in anger grabs a bucket of water and throws it on the wicked director, who begins to melt. The elders rejoice in their freedom and ask the lonely old lady to come live with them, and the helpless old man to become their new leader, and the bored old woman to become head of all activities. All agree to do so after helping Amanda return to the Golden City and home.

When Amanda and her friends meet the great Czar again, he tries to put them off. Yoshi accidently tips over a screen in the corner of the Czar's throne room, revealing an old man who had journeyed to Oz a long time ago in a hot air balloon. Amanda and her friends are heart-broken to learn that the Czar has no awesome powers to help them.

But then Amanda correctly points out that they all have the power within to change and that the antidote to the 3 plagues of lonliness, helplessness and boredom are simply:

• Loving & meaningful companionship and a life that revolves around relationships in a truly human community with children, plants and animals.
• A community that balances both the ability to give care and receive care gracefully.
• A life filled with variety, spontaneity and choice.

At Glinda's palace where they head to next, the travelers are greeted warmly, and it is revealed by Glinda that Amanda had the power to return home all along. The silver pen she held in her hand can take her anywhere she envisions. She tearfully embraces her friends, all of whom will stay in Oz and flourish in their new roles with all the other elders and people of Oz.

Amanda and Yoshi return to Rochester where she continues her "pathways journey" with all her peers, determined to destroy the wicked 3 plagues of lonliness, helplessness and boredom that continue to account for much suffering among the elders back home. She dreams of the day when all of the country becomes like Oz and all our elders rejoice in the joy of meaningful living forever.

THE END!

Dedication of the new Valley Manor Courtyard Garden

We recently had the formal dedication of our new Valley Manor courtyard garden. After several months of planning and renovation work, the final product was completed and we are thrilled with the results. The new area is much more accessible and safe for residents and the beauty of the design provides a wonderful place for outside group activities or peaceful individual enjoyment.

The "before renovation" pictures to follow illustrate the vast improvement. In addition to replacing all the brick work, we added a gazebo and water fall pond. We reused many of the plants, but reworked the layout and added many other plants and amenities to the courtyard.

This project was only possible through the generous contributions of the Valley Manor residents over the past 2 years and a special gift from the Schmitt Foundation in honor and recognition of former Valley Manor CEO, Mike Walker.

We look forward to many splendid hours and activities enjoying the beauty of our new Valley Manor courtyard garden.

Congratulations to Sam Scorsone in Purchasing who won the $25 Wegmans gift certificate random drawing from last week's Blog.

"Win a Wegmans Gift Card" Blog Contest & Tutorial

My wife Jennifer is teaching an on-line law course for RIT students this Fall. Both my son and daughter-in-law received their Master's degree from an on-line graduate program at Marist College. What a great concept! On-line, on-demand, when you can.

I worked part-time tending bar while attending college and can still remember how difficult it was to work until 2 a.m. and then drag myself out of bed for my Friday morning economics class. Where was this on-line course study back then?

Anyway, I was recently asked to present a short tutorial on nursing home reimbursement for a group of community leaders serving on a commission to help formulate a vision for how the greater Rochester area should provide healthcare for seniors in the future. So I dusted off an old summary, honed and updated it and voila! Then I thought, "why not share it with my blog readers as an informative on-line tutotorial."

Now you won't earn any college credits for taking the time to read this, so instead I have decided to offer all who take the time to read it a chance to win a $25 Wegmans gift card. If interested, read the tutorial to follow and then follow the simple instructions and contest rules to enter your name for a chance to win.

Nursing Home Reimbursement 101

Although the reimbursement methodology for nursing homes is riddled with complexities, nuances, adjustments, ceiling caps and other various amenities, in its simplest form can be summarized as follows:

Medicaid (on average represents 65-70% of patient day utilization, 50% of service revenue)

Medicaid Assistance helps pay for the cost of nursing home care for those who meet specific resource and income limitations and are qualified by the Department of Human Services. Medicaid pays the NH a facility-specific per-diem less any portion of that per-diem which is determined to be the responsibility of the resident based on their net available monthly income (NAMI).

The facility-specific Medicaid per-diem rate is determined by compiling the facility’s base-year (1983) costs into 4 distinct categories:

1) Direct Costs (i.e. nursing, therapies, pharmacy, social work)
2) Indirect Costs (i.e. administration, maintenance, laundry, housekeeping, dietary)
3) Non-Comparable (i.e. physicians, dental, speech & hearing, utilities)
4) Property Costs (i.e. depreciation/principal, interest, insurance, rent, RE taxes)

The facility base-year direct costs are then adjusted by a facility-specific case-mix factor and a regional price index factor and divided by the facility’s total patient days to arrive at an adjusted cost-per-day. A clinical assessment tool (MDS), designed to measure resident acuity and resource utilization, determines the case-mix factor. This rate is then compared to a similar state-wide average cost-per-day and if your cost falls within a corridor established at a 95% floor and 105% ceiling, you receive your actual case-mix adjusted cost-per-day. If you fall below the floor, you receive a case-mix adjusted floor and if you fall above the ceiling, you are held to the case-mix adjusted ceiling.

The same process and formula is applied to your facility-specific indirect costs, except there is no case-mix factor applied since resident acuity is not a significant cost driver of indirect costs.

The facility-specific non-comparable costs are divided by total patient days to arrive at an actual cost-per-day and are reimbursed at cost.

Property costs are not reimbursed on base year costs, but instead are reimbursed at actual cost on a two-year lag based on reported costs. Major capital additions are subject to prior approval via the Certificate of Need (CON) approval process and all reported property costs are subject to subsequent audit & review by the Department of Health.

The sum of the calculated per-diem for direct, indirect and non-comparables is then trended forward from the base-year to the current rate year using an aggregate inflation factor established by the Department of Health. The facility-specific property cost per-diem is added to this sum along with other minor per-diem adjustments to establish your facility-specific Medicaid rate.

Medicaid Reimbursement Issues

* 1983 base-year costs are no longer very representative of the cost structure of the current nursing home operation.

* The annual trend factors designed to adjust the base-year costs to current costs have not kept pace with actual cost movement.

* On average the Medicaid rate computes to 75-80% of actual cost-per-day.

* Medicaid eligibility process can result in lengthy cash flow delays (> 6 mos.) or subsequent denial of coverage that often results in sizable bad debts.

* Medicaid case-mix adjustment methodology has recently been changed to only utilize Medicaid residents in the calculation, thus further reducing the reimbursement due to higher acuity Medicare skilled residents not being factored into the case-mix adjustment.

* Effective 4/1/2010, the methodology will be changed dramatically when Medicaid intends to move from facility-specific costs for direct, indirect and non-comparable to a regional average price for all within that region. This is expected to dramatically re-allocate Medicaid per-diems creating both “winners and losers”, while driving future costs towards decreasing averages.

* Medicaid loopholes and sheltering of assets has significantly added to the growing number of Medicaid recipients as the private pay sector diminishes and the public sector grows, further straining the State Medicaid budget.

* Medicaid reimbursement shortfalls result in nursing homes having to limit the number of Medicaid admissions they can take, which subsequently leaves many Medicaid residents without access to the proper level of care or backed up in hospitals.

Medicare (On average represents 7-10% of patient day utilization, 10-15% of service revenue)

Medicare Part A covers skilled nursing inpatient care for those over 65 year of age (or disabled) for a period up to 100 days in any one spell-of-illness. Skilled nursing care is a Medicare defined term that requires the patient to be receiving and needing certain high-level skilled services related to an acute care episode and minimum 3-day hospitalization. A new spell-of-illness is defined when a patient has an onset of a new acute care episode after a minimum of 30 days has passed from the last episode. Medicare beneficiaries can choose a Health Maintenance Organization (HMO) plan in lieu of traditional Medicare benefits. HMO plans generally follow traditional Medicare benefits, but can offer some enhanced variations. Medicare Part B covers physician services and certain skilled therapy services when provided outside of a Medicare Part A covered stay.

Medicare does not pay a facility-specific rate, but instead pays an established price for an array of over 50 Diagnostic Related Groups (DRGs). A patient is classified into the proper DRG based on the completion of a clinical assessment tool (MDS). A series of MDS are completed throughout a patient’s Medicare Part A stay, resulting in the potential for different DRG Medicare per-diem rates paid within a stay. Medicare DRG rates vary significantly and are driven by the assumed DRG medical acuity and resource utilization need. On average, Medicare rates fall between $300-400/day. The average Medicare Part A covered stay falls between 20-30 days and is generally a function of the duration of the need for skilled care, the potential for documented progress and the approval of the HMO case managers. Medicare Part B pays an established fee for billed physician visits and therapy treatments provided to Medicare beneficiaries in a nursing facility during a non Medicare Part A stay.

Medicare Reimbursement Issues

* Although the rates are significantly higher than Medicaid, the cost to care for these clinically complex patients is also significantly higher.

* Medicare has been continually decreasing the DRG price structure to address Medicare budget restraints.

* While on a Medicare Part A stay in a nursing home, the nursing home assumes payment responsibility for most all medical needs regardless of who or where these needs are met (excludes hospitalization, radiation treatments, prosthesis).

* Maximization of DRG payment requires significant documentation and process to ensure you capture all clinical interventions and thus receive the most favorable rate.

* Most Medicare Part A stays are short-term rehabilitation patients cared for in distinct rehab or transitional care units of nursing homes and are highly sought after by nursing homes.

* Federal government is actively pursuing a new Medicare payment methodology where Medicare payments for all providers of service (hospital, nursing home rehab, physician, home-care) to a covered beneficiary during any one spell-of-illness will be paid to a single “controlling entity” at an all-inclusive established capped price for that DRG. The “controlling entity” will be responsible for providing, contracting out and allocating the Medicare DRG payment among the various providers of service. Medicare’s payment is capped, while the “controlling entity” and its care partners own risk management and cost control.

Private Pay (on average represents 20% of patient day utilization, 25% of service revenue)

Private pay residents are those who do not qualify clinically for a Medicare Part A stay (although they may have Medicare coverage), and they do not qualify financially for Medicaid. Assuming they do not have other means of insurance (and most do not), they are responsible for paying the facility-specific private pay rate as agreed to in the admission agreement. The average private pay rate in this region is approximately $330-350/day for long-term care and $400 or more for short-term rehab.

Private Pay Issues

* Medicaid reimbursement shortfalls force providers to subsidize losses through higher private-pay rates thus shifting the Medicaid cost burden onto the private sector.

* More individuals are sheltering assets to qualify early for Medicaid Assistance, thus reducing the private pay sector.

* The Medicaid Assistance application process for private pay residents transitioning to Medicaid Assistance can be so demanding and difficult that many fail to follow-thru or qualify leaving the nursing home with extensive bad debts.

* The State currently assesses nursing homes a 6% cash receipt “tax”, which is generally passed on to private pay residents as a 6% (approximately $20/day) add-on to the private pay rate, further shifting public costs to the private sector.

Summary

A typical simplified 120-bed nursing home operating structure (based on industry averages) might look as follows:

Medicaid Revenue 29127 days (70%) X $185/day = $5,388,500
Medicare Revenue 4161 days (10%) X $400/day = $1,664,000
Private Pay Revenue 8322 days (20%) X $330/day = $2,746,000

Total Service Revenue 41610 days (95% occupancy) $9,798,500

Total Operating Expense $235/day = $9,778,350

Operating Margin .2% $ 20,150

Congratulations, you have successfully completed the Nursing Home 101 tutorial. To enter for your chance to win a $25 Wegmans gift card, simply click on the comment button and leave your full name (and a brief comment if you desire). You can use the URL option and just type in your name or use the anonymous option and just type in your name in your comment box. Only one entry per person and all my blog readers are eligible (staff, board members, volunteers, family and friends). One gift card per every 20 entries (up to 5 winners in total) will be randomly chosen from the list of names on Saturday, September 12th.

Good luck and thanks for reading and learning from my blog!

The Workers Compensation Story

If you only like light-hearted, fun blog postings then you might want to skip this week's entry as I plan to dedicate this posting to a recap of our 15 year history with a unique self-insured workers compensation Trust joint-venture. While it may be informative, I can't promise you it will entertaining. So proceed at your own risk...........

In 1992, a group of 8 nursing homes created a self-insured group Trust for the purpose of providing statutory workers compensation benefits for its members. Workers Compensation pays for lost time and medical expenses associated with a work-related injury. While nursing homes and related senior communities don't have the same injury risks as manufacturing companies, they actually have high claim experience due to claims and risk associated with lifting and positioning residents.

In the 90's, conventional insurance policies and the default option State Insurance Fund had become high cost and low service options. Many organizations were looking to take more control by self-insuring this mandatory program. Unfortunately, unless you were a very large organization, self-funding was generally considered to be too risky and cost prohibitive. Thus the advent of joint-venture Trusts where several organizations joined forces to pool their premiums, risks and costs.

In 1994, Kirkhaven joined the Long Term Care Risk Management Group (LTCRMG), which had increased from the original 8 members to now 15 members. Members included both not-for-profit and for-profit nursing homes, assisted living and retirement communities in the Rochester and Buffalo area. Potential members were screened and had to meet certain minimum financial, loss control and claims experience requirements.

In short, the Trust was structured to allow all the member organizations to share in the routine overhead costs associated with a program like this while self-insuring their workers compensation risk. These include:

• Program Management
• Claims Administration
• Loss Control Services
• Auditing & Actuarial Services
• Reinsurance Premiums

Each organization pays into the Trust based on a standard formula applied to their total payroll exposure modified by a organization-specific historical claims experience factor. However, your ultimate program cost is your actual claims experience for your organization plus your pro-rata share of the non-loss administrative costs. To help mitigate the exposure for large losses, the Trust includes a large loss sharing formula among all members and also purchases reinsurance to cover very large claims. Every year an accounting of each members premiums paid minus the total cost of claims paid, reserves established and pro-rata overhead costs results in either a refund or additional assessment to continually balance your ledger until all claims in that year are ultimately closed.

The benefit of these self-insured Trusts is that you could control the service providers and ensure you are getting the service you desire or fire them and hire someone else. There are no insurance company profits built into the costs and the investment income earned by the claim reserves inures back to the Trust and the members to help offset costs. You still need to manage your risk and control claim costs as best as possible, but the structure of a self-insured Trust simply sets up better to control and manage both claims and cost.

While it is not possible to accurately know what the alternate insurance market rates might have been in future years to enable us to compare historical costs and savings, there is no doubt that the Trust saved us significant dollars over the early years. In 2000, we added Valley Manor to the Trust, which had now grown to over 30 members.

Within the past several years, the federal workers compensation program has undergone significant changes, scrutiny and regulatory reform. Additionally, many self-insured Trusts have gone bankrupt or terminated leaving unfunded liabilities in the hands of the State. In turn, the Workers Comp Board of the State has levied higher assessments and more stringent regulatory requirements on remaining self-insured Trusts to recapture losses and minimize risk for future losses. This action has made it more difficult for Trusts like the LTCRMG to operate and compete with other workers compensation insurance programs.

Within the past few years, the challenging economy and tougher Trust restrictions has resulted in nearly half of the LTCRMG members terminating their participation in the Trust. Additionally, both current and former members have fallen behind on their payment obligations resulting in higher accounts receivables and risk of bad debts. Six former members have either gone bankrupt or left the group with bad debts totaling 2.2 million dollars, resulting in legal costs to attempt to collect and/or reallocation of the bad debt cost to the other members.

As the once solid core of our innovative Trust begins to unravel, the handwriting is on the wall. The Trust must be dissolved. What was once a viable solution to a problem has now been faced with a changing scenario that questions the on-going value of this Trust as structured. Our goal now is to manage a responsible and organized exodus that also includes a new direction for how we will provide workers compensation benefits.

The tough reality is that no matter where we choose to go from here, none of the LTCRMG members can "run" from the cost or claims still in the works from all previous years. We can close and lock the "barn door", but the "cows" that have already left are still all of our responsibility. The board of directors of the LTCRMG, which is comprised of the CEO or CFO of each member, is taking on the responsibility of working with our legal advisers and program administrators to enable us a "soft landing" with the least amount of cost and risk.

From my perspective, the LTCRMG was an excellent program in its time, but has now become too costly and risky to continue as a viable option. Sadly, it is time to move on to something else and our challenge is to mitigate the transition cost and find the next new solution for today's workers compensation environment.

Dear Diary

Tuesday, August 11..........Dear Diary:

7:30 a.m. I'm back at work following a wonderful week vacation. I didn't leave town, but had a blast spending time on the boat, taking kayak trips, going to a concert, taking in a baseball game, knocking off household projects and working on the writing of my novel. Weather was great and I had a relaxing week. Having a hard time getting used to wearing shoes and a tie again.

8:30 a.m. A lot of people stopped by to welcome me back. My desk and work load isn't to bad. The nice thing about not going away on vacation is that I was able to check my e-mail and voice mail daily. I found by spending a little time each day managing my office data it kept things from piling up upon my return. Kirkhaven Administrator, Amanda Brown, stopped in to say hi and get me caught up on things. Quiet week while I was gone. Poor Amanda, she has been trying to schedule a vacation of her own, but is afraid the Health Department will show up for their annual surprise inspection while she is gone. Now that I'm back, she has finally decided she is starting her vacation tomorrow.

9:00 a.m. What's all the commotion outside my office? Uh oh, I think we have visitors. Like wild fire, the word spreads throughout the nursing home. "The Department of Health surveyors are here!" A team of nurses, sanitarian, dietitian, social worker have arrived armed with lap tops, manuals and paperwork. Amanda has postponed her vacation plans. Let me see, at this time yesterday I was kayaking out on the Genessee River. Welcome back to work Jim.

Noon It's hard to explain the atmosphere during a survey. We go about our business as usual, but it is like someone just pushed the "fast-forward" button on your life but you're running in knee deep sand. Everything we do is under the microscope and magnified. The surveyors observe, ask questions, talk to residents & families, review charts, dig deeper, ask more questions, watch your every move as you try to go about your "normal" day. I guess you could say it's a little intimidating and nerve wracking for our staff.

5:00 p.m. End of the first day. According to Amanda, all is good so far. Staff is okay and nothing major appears to have surfaced. Time to go home, this working for a living is tiring.

Wednesday, August 12........Dear Diary:

9:00 a.m. I can't believe I'm stuck in this meeting across town. Didn't the rest of the world get the memo about the surveyors being at Kirkhaven? Doesn't our regular work go away when the annual State survey is underway? This is a pretty important meeting in its own right, so I need to focus. I know Amanda and her team have things under control at Kirkhaven.

11:00 a.m. Finally, this meeting is over. We accomplished a lot. I'm helping to lead a potential shut-down of our self-insured Workers Comp Trust, which we participate in along with several other health care organizations. A significant initiative with critical implications. I wonder how the survey is going today.

1:00 p.m. "Houston we have a problem!" Seems the coffee temperature is too hot according to the surveyors. Could cause serious injury to our residents. But our residents like hot coffee and often complain it's too cold? According to the surveyors, this could put us at an "immediate jeopardy" deficiency level. That's not good! Immediate Jeopardy (IJ) means no new admissions and potential fines until the problem is adequately resolved.

4:30 p.m. Still a lot of commotion going on about coffee temperatures. Surveyors taking coffee temperatures throughout the house. We pulled the plug on the coffee dispensers on each floor and started serving coffee from urns. The coffee vendor has been called. Amanda copies me in on an e-mail from our Medical Director entitled, "Coffee, Tea or IJ". You have to have a sense of humor to get through this stuff. I wonder what tomorrow will bring.

Thursday, August 13.......... Dear Diary:

8:00 a.m. Amanda and I met with our Medical team Director. Our new physician team is awesome and all is well, but we need to work on some coordination issues to ensure the staff and physicians are working as efficiently and effectively as possible. We identified some good ideas and a process to begin working on this. I wonder how the survey is going today?

10:00 a.m. I had to attend an important meeting with the County Department of Human Services. I'm working with other industry representatives on a unique initiative to help expedite the vast backlog of Medicaid Assistance applications that cause critical cash flow issues for nursing homes. The meeting is very productive and we agree in principle on a process to move forward with.

noon I met with Amanda to get an update on the survey. The coffee debacle seems to be resolved for now. A few other issues are cropping up. Nothing devastating, but the normal little things that eventually happen when under the microscope. There are so many resident interactions within a day, so many clinical treatments, so many opportunities to both do well and slip up, that eventually the surveyors will find something to write you up about. That's just how the system works. The surveyors are just doing their job, no different than us.

2:00 p.m. I went to participate in the Valley Manor Newcomers Welcoming party. What a nice respite from the rest of my week. We have had a lot of new residents move in over the past several months. All have such interesting backgrounds. All the residents come to meet and greet everyone. It is a lovely event and enjoyed by all. The renovated Valley Manor courtyard is finishing up and looks great! I wonder how the survey is going?

Friday, August 14.............Dear Diary:

7:00 a.m. Early start today. I'm finishing up two big projects. The first is the completion of our annual IRS filings for our 4 corporations. These are usually done by our auditors, but there are significant changes in the forms this year and there's no way a third party can complete them without us providing them the information anyway. The filing has gone from approximately a 10 page form to a 25 page form. I can't ask the finance office to take on yet another project. Sometimes I find that the best way for a CEO to stay in touch with the organization is to immerse yourself in the operation. It's a fine line between micro-managing and staying informed, but I like to walk it. The second project is the compilation of the Assisted Living licensure application data to submit to the State. Staff have been working hard on this and we appear to be getting to the end of the long process.

10:00 a.m. Spoke with Amanda for an update. She seems a little ragged. It's been a long week. She shared some incidents that the surveyors and staff have shared with her. Seems like some potential for deficiencies are adding up, but still nothing real major. Then again , maybe we're just paranoid at this stage of the game.

Noon Had lunch with board member, John Billone, a local developer. We had good conversation about the Kirkhaven Replacement Project and the current property opportunity we are evaluating with Buckingham Properties for the old Armory site on Culver Road. Some good ideas, input and support from John who is very knowledgeable about the property and development projects in general. The survey exit conference is scheduled for 2 p.m. today.

2:00 p.m. The survey team leader sits down with our entire leadership team in the conference room. We open up the Exit Conference to the entire team. We work as a team and we take the good and the bad as a team. The survey team leader begins with her scripted disclaimers and instructions. She then begins to identify the survey team findings which represent the "potential" for any deficiencies. She indicates there are no deficiencies that represent substandard care. Nice, we're off to a good start!

She then proceeds to identify 3 circumstances whereby they witnessed a failure of staff to properly wash their hands, which is an infection control issue. I struggle to keep up with my notes as she rattles off the details. Then she begins to thank us for our cooperation during the survey and do we have any questions. "Uh.........is that it?" I wonder to myself. Could I have dozed off for 20 minutes and just woke up in time for the concluding remarks? The room is stunningly quiet as Amanda escorts the survey team out and sees them to the front door.

I never noticed before how long it takes for the conference door to close itself. When it finally clicked closed, everyone looked at everyone else and burst into a collective sigh and then laughter. "What just happened?" everyone asked. "Well," I said, "It appears we just aced our survey with the potential for only one little deficiency of minimal scope and severity."

When Amanda returned she had the biggest smile on her face that any of us have ever seen. "Amazing job everyone," she said. "we did it!" The key word being "we". It has been a long and tiring week for all, but because of the work of all, we aced our survey. Now I still believe that the State survey is only one measure of our quality, and arguably not even a great measure. But it is a measure and a critical component of our regulatory compliance requirement and public relations. We take it seriously and thus are overjoyed with our awesome results!

3:00 p.m. "Great job everyone. Take the rest of the week off," I said to an exhausted yet elated leadership team.

p.s. Thank you Amanda for your incredible leadership and enjoy your well-deserved vacation. Thanks for visiting my Blog. Talk to you all again next week.

Seniorsfirst Musicfest

"Add another event to the list of Rochester's successful summertime music festivals", said the Democrat & Chronicle in its front page local newspaper article highlighting the Seniorsfirst Musicfest.

The Seniorsfirst Musicfest at Valley Manor is a three-day public event featuring Opera and a harpist on day 1, the Gateswingers Big Band on day 2 and the Rochester Philharmonic Orchestra on day 3.

Over 1500 attendees enjoyed the diversity of music, food and fun over the three days. Despite the threat of or intermittent rain, all 3 shows dodged the storms and the crowds came out to enjoy the event.

My vision for the musicfest is to become the premier venue for music for seniors. Rochester is known for its music festivals, but only the Seniorsfirst Musicfest is truly senior-friendly and aimed to meet the musical tastes of seniors.

In addition to showcasing our Valley Manor Apartments Community, the Musicfest also provided priceless public relations for all our Seniorsfirst Communities & Services. We also held a special VIP Donor luncheon in conjunction with the RPO Musicfest day to thank and recognize key supporters of our Kirkhaven Replacement "Pathways" project.

All in all it was a very busy, yet very successful 8th annual Musicfest. An event of this magnitude is only successful because of the dedicated and hard working team of staff who collectively do all the many tasks that go into producing an event of this magnitude.

Bravo to all and thanks to our many sponsors and attendees for supporting Seniorsfirst.

A Tale of Two Families

"It was the best of times, it was the worst of times,..............". These are the opening words of Charles Dickens' "A Tale of Two Cities" as he wrote about the triumphs and struggles of the human emotions and reactions related to the period of time just prior to the French Revolution.

These same words could also be used to tell of the triumphs and struggles of the human emotions and reactions related to the period of time when a loved one requires nursing home care.

I was reminded of this recently when I received two polar opposite letters from the family of two different residents of Kirkhaven. The first was hard to take and it clearly illustrated a family struggling with the challenges and emotions associated with watching their father age and dealing with the medical acuity and failing health related to the aging process.

• "Your facility appears to function without a shred of loyalty, compassion and communication."
• "Kirkhaven could care less about the residents and it's sense of professionalism."
• "Kirkhaven certainly does not operate as a family institution."
• "It's all about the MONEY."

These are just some of the quotes the writer used to share their concerns and issues related to the care their Dad received while he was a resident at Kirkhaven for 7 years. Seven years translates into 2,555 days of care or 61,320 hours of care. A long period of time, however you choose to define it, and a period of time undoubtedly filled with both triumphs and struggles for all parties.

What a shame that the last few struggles weigh the heaviest on every one's mind. Could we have been more attentive and sensitive to the resident's and family's needs? Could the family have been more understanding and sensitive to the issues? I'm thinking yes to both, but it isn't always easy to be a family advocate or a caregiver when dealing with the challenges of aging.

And then I received the second letter from another resident's family, which clearly illustrated an entirely different perspective and opinion related to the care Kirkhaven provides.

• "When I visited Mom, I was so pleased.......she was clean,calm,appeared contented. She was clearly enjoying her life."
• "I believe Kirkhaven gives Mom the best quality of life she's capable of having at this stage of her life."
• "Mom's caregivers at Kirkhaven are taking the time, interest and patience to really know and care for her."
• "Thank you for helping us through this transition. Words alone cannot express how grateful we are."

Those are just some of the quotes this writer used to share their joy and gratitude for the support and care Kirkhaven has provided during a very difficult and challenging time with their aging mother. The need for her to move to a nursing home was initially accepted with fear and anxiety, but now has brought them peace of mind.

Two completely opposite letters. Which accurately reflects the true Kirkhaven? Perhaps it isn't really about Kirkhaven at all, but more about the the normal emotions and reactions to life and the aging process.

Yes indeed, Charles Dickens had it right. It was the best of times, it was the worst of times!

Senior Living Meets Global Aging

I recently attended an educational session that took an interesting approach to the future challenge of senior living and global aging. I shared an overview of the session with the Seniorsfirst board of governors as a mini-education item within our regular agenda.

I thought my Blog readers might enjoy the innovative and informative perspective as well. I'll break it down into 3 parts for you:

1. Global Aging
2. "Nana" Technology
3. The "Next Generation" of Senior Housing

Part 1: Every 8 seconds a U.S. baby boomer turns 60. There are 78 million of us born between 1946-1964. The U.S. population of age 85+ is expected to double from 4.3 million (2000) to 8.5 million (2030), then double again to 18.2 million (2050).

• 1900 U.S. census recorded 3,536 people age 100+
• 2050 U.S. census estimates 834,000 people age 100+

Global aging will affect us long before global warming!

So here are two questions we should be asking:

1. Who will take care of them?
2. Where will they live?

You should also know that 80% of current senior care is provided by 34 million unpaid "caregivers" (family or friends). But this informal structure of care giving is collapsing as you read this.

• Time: dual-working spouses means less care giving time
• Proximity: 20% of family caregivers live an average of 480 miles away
• Energy: If your Mom is 100..............how old are you?

You should also know that there is a growing professional caregiver labor shortage to meet the growing demand.

• 35 million more jobs of any kind than people to fill them by 2030
• 2 million long-term care nurses and nurses aides today, 6 million needed by 2050

So what is the answer you might be asking? Well fortunately, there may be some answers to mitigate the issue:

1. Congregate staffing: we need to group available workers in facility-based environments to produce efficient use of available labor force. Should home-care be a right or a privilege? There is a good cost reason why the government doesn't fund "home-schooling".
2. "Nana" technology: utilize technology that allows seniors to remain independent longer and/or make congregated labor more productive.
3. Congregate housing: create housing models where seniors want to live!

Part 2: "Nana" technology is unofficially defined as microchip-based technology designed, intended, or that can be used to improve quality of life for older adults. There are real examples of such technology that are currently in development or study and that will have a significant impact on care giving in the future.

• Magic Medicine Cabinet- face recognition and voice communication that will take blood pressures, monitor vital signs, maintain medical history, remind and dispense medications.
• Smart Shoes: monitors balance deficits and signals the brain to adjust accordingly. A recent pilot study resulted in 73-year olds having same balance as 23-year olds.
• GPS Xplorer Shoe: tracks within 30 feet anywhere on planet. So a caregiver can be miles away and receive a notification if a loved one wanders outside of their established routine.
• Virtual Dinner Window: a large picture frame hangs on the wall next to your dining room table where a family is enjoying dinner and conversation along with grandma, who appears to right beside them but is actually miles away.
• Smart Shirt: a lightweight t-shirt that monitors vital signs and conducts safety monitoring. A version is being tested that can actually perform CPR when vital signs indicate. Now when you are told to make sure you're wearing your good underwear, you'll want to do it!
• Ri-Man Robot: can "see, hear and smell" and currently lifts up to 90 pounds. Next phase to be designed for assistance to Japanese elderly.

Part 3: By 2050, there will be more than 2 billion people in the world over the age of 60...............and every one of them will be a unique individual. Baby Boomers will change the face of senior housing and long-term care just like they have done at every other juncture of their life.

Before Boomers, there were 3 flavors of ice cream.........now there are a thousand!

Before Boomers, there was Coke and Pepsi...........now just within the cola's there's regular cola, diet cola, cola one, vanilla cola, cola with a twist of lime and on and on!

Boomers want individual choice and variety. They will demand the same when it comes to senior housing and long-term care. And by the way, Boomers are not attached to their homes forever, nor do they want to live alone. They have never been alone!

• Boomers created large suburbs
• Boomers attended large high schools
• Boomers graduated from large universities
• Boomers worked for large companies
• Boomers will move & live together if offered the housing choices they desire

So what are the new "flavors" of senior housing and long-term care?

• "Culture Change" nursing homes: the new wave is smaller residential household communities that do away with the current medical model and instead focus on resident centered & directed care in a more home-like setting.
• Housing for different cultures: an example is Aegis Gardens in Freemont, California where all 50 staff speak Mandarin, Cantonese or Japanese and features Asian cuisine, architecture, activities and customs.
• Housing of "different orientations": Rainbow Vision in Santa Fe, New Mexico is dedicated to gay, lesbian, bisexual and transgender older adults. It features the Billie Jean Fitness center, Truman Capote Dining Room and Drag Queen Bingo.
• Housing "at Home": Beacon Hill Village in Boston, Massachusetts resides in the heart of one of America's oldest neighborhoods with convenient access to shopping, transportation, banking, eateries within the area and home health services provided if needed.
• "On the road" housing: Rainbow's End RV Park offers 42 sites with wheelchair ramps and assisted living services and health care services via a home health agency.
• Housing for "Alums": More than 100 communities open or in development that are university based retirement communities. Residents gain access to classes, athletics, arts & library while universities retain alumni relations and donors.
• "S.S. Assisted Living": An 89 year-old widow living on the QE2 since 2000 and will visit 41 cities, 25 countries, 5 continents in one year! Provides all housekeeping, meals and activities at a cost similar to the average assisted living facility. Three cruise ship companies establishing "Residential Ships" for retirees by 2010.
• A real "niche" community: In Pasco County, Florida (the nudist mecca of North America) nudists are planning an assisted living facility. There are an estimated 50,000 nudists in the U.S with a median age of 55. If they haven't been wearing clothes all their life, why should they start when they grow old? (that's a rhetorical question, you really don't need to answer!).

In the nest two decades, individuals age 65 and older will come to represent 1 out of every 5 U.S. citizens. They will be ready to embrace new technology, new forms of retirement and new forms of senior housing and long-term care communities.........................Will we be ready for them!

Thanks for visiting my Blog. I'm taking a short summer vacation up at the cottage in the Adirondacks on Indian Lake in conjunction with the July 4th holiday week. I'll share some pictures and more thoughts upon my return.

Seniorsfirst Recognition Luncheon

On Wednesday June 24, Seniorsfirst recognized and honored 68 employees and volunteers at our annual Employee/Volunteer Recognition Luncheon. This year we held the event at the prestigious Oak Hill Country Club (home of past PGA US Opens, PGA Championships and Ryder Cup).

The venue was superb as we dined on a delicious buffet cuisine prepared by the professional chefs and culinary staff in the grand club house atrium. We enjoyed the company and fellowship of one and other as we dined and left behind (for at least a while) whatever work and challenges waited for us back at Kirkhaven and Valley Manor.

After lunch, we enjoyed the viewing of a video production featuring all of our honorees prior to individually recognizing each with a special gift of gratitude to mark their service milestone. Collectively, we honored over 830 years of service broken down as follows:

• 19 five-year honorees
• 10 ten-year honorees
• 5 fifteen-year honorees
• 7 twenty-year honorees
• 14 twenty-five honorees
• 1 thirty-five honoree

Additionally, we honored our 6 "Compassionate Heart" award recipients over the past year, 3 individual volunteers who have been with us over 15 years and 3 volunteer board members who collectively have given over 100 hours of their time, talent and resources in the past year.

As I reflect on what this day means to Seniorsfirst, I am first in awe of the dedication and loyalty of our staff. In an age where time seems to be measured more in minutes than years, I find it remarkable that we have so many employees and volunteers who choose to serve with us for most of their individual career.

Second, I am reminded that there is no single leader or group at Seniorsfirst that is responsible for our success. We are one team and everyone is a full team member. Each of us has a specific role and brings a unique talent to the table. It is this wonderful diversity of members that creates balance to our team and enables us to provide such exceptional performance. Individually, each of you is special and each of you represent an important part of our organization. Collectively, you are simply the best and represent an awesome Seniorsfirst team.

Third, as I reflect on my own milestone of 25 years of service, I recognize that whenever I get stressed or worried about the challenges we face, I only need to look as far as the people around me. You all are the reason that Seniorsfirst exists today and you all are the reason we will continue to flourish in the future.

On behalf of Seniorsfirst, congratulations to our 2009 service milestone honorees and thank you to all our Seniorsfirst employees and volunteers. At Seniorsfirst, our people make the difference!

Here are some photos of today's event (some are little dark due to poor lighting)...........................