Tag Archives: assisted living

Find out how demographic shifts affect the aging community in your area

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

The population of people 65 and older is growing, but not equally across the United States.

Some cities are experiencing sharp increases in the number of older residents; in other areas, this group is expanding more slowly.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

These population trends are important because “the benefits and challenges of a growing senior population will hit each metro region differently,” notes John K. McIlwain, the J. Ronald Terwilliger chair for housing at the Urban Land Institute, in a recent article reprinted in The Atlantic Cities.

In urban areas with large numbers of seniors, health care and housing needs will be different in kind than in communities with a younger population. More programs that help people age in place will be important, as will access to services such as home health and custodial care, transportation, assisted living, and hospital, physician, and rehabilitative care.

Also, seniors are “more politically conservative, and what they want and need from a community is often quite different from what young families want and need,” McIlwain notes. “This is changing the local political climate in places where the growth of seniors is significant. Seniors are, for instance, pushing for more parks, open space, and libraries, often at the expense of funds for schools and playgrounds.”

The data McIlwain cites in his article is based on an analysis of the 50 largest metropolitan areas in the United States and spans the period from 2000 to 2010, a decade divided by the housing boom that occurred in its first half and the housing bust/recession that dominated its second half.

During this period, urban areas with the fastest-growing older populations were Raleigh, N.C., Austin, Texas, and Las Vegas.

Rank Metro Area Percent Growth
1. Raleigh 60 percent
2. Austin 53 percent
3. Las Vegas 50 percent
4. Houston 39 percent
5. Dallas 38 percent
6. Charlotte 36 percent
7. Phoenix 33 percent
8. Denver 32 percent
9. Orlando 29 percent
10. Riverside 28 percent

New Orleans, hit by Hurricane Katrina, lost residents 65 and older, as did Pittsburgh, Penn., and Buffalo, N.Y.

Rank Metro Area Percent growth
1. St. Louis and New York City (tie) 7 percent
2. Detroit 6 percent
3. Milwaukee 4 percent
4. Tampa 4 percent
5. Philadelphia 4 percent
6. Providence 1 percent
7. Cleveland 1 percent
8. Buffalo -3 percent
9. Pittsburgh -5 percent
10. New Orleans -5 percent

The nation’s two largest cities topped the list of cities that gained the most older residents. But this number is less meaningful than growth rates, because these metropolises have enormous populations to begin with.

Rank Metro Area Number of New Seniors
1. Los Angeles 199,000
2. New York City 167,000
3. Dallas 153,000
4. Atlanta 147,000
5. Houston 144,000
6. Phoenix 129,000
7. Washington, D.C. 127,000
8. Riverside, California 98,000
9. Chicago 87,000
10. Minneapolis 69,000

It’s easy for you to compile similar data for your community: Look at Census Data for 2000 and 2010 and compare the 65-plus population in those years. For help doing that, this tip sheet by Frank Bass has tips on using Census data for health reporting.

If you want to dig in deeper, talk to your city’s planning department about projected growth in the senior population through 2020. Are planners studying what this population will need going forward and how to make your area more senior-friendly?

Ask local hospitals what portion of their business comes from Medicare and how they expect this segment of their business to grow. Are they undertaking any special efforts to appeal to the growing senior population?

Find out what senior housing operators are planning for your community. Are new assisted living centers or other types of housing being built? Are new services designed to help seniors age in place being offered?

Try to understand the costs associated with a growing older population. How will budget-strapped cities and counties handle this burden? What tradeoffs are entailed?

Finally, McIlwain wisely notes in his piece that the trends of the past decade won’t necessarily hold going forward. Clearly, economic woes have hit older adults hard and affected their retirement portfolios, their ability to sell homes, and their plans for the future. This, too, is a trend to watch as you keep an eye on the senior population in your community.

Dining decision brings discrimination issues in aging to forefront; lessons for reporters

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

Paula Span of The New York Times clearly struck a nerve with her recent story about an upscale retirement community’s decision to exclude certain residents from its country-club style dining room.

The residents in question lived in assisted living apartments or a nursing home that are part of the Norfolk, Va., continuing care retirement community (CCRC).

For years, some had eaten in the main dining room, with its white-clothed tables, fancy food and nice views, without a fuss.

But last year, management at the complex decided that only people residing in independent living apartments could take their meals there.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Residents of assisted living would have to eat in their own dining room, as would nursing home residents, management declared.

Yes, it’s a form of segregation, based on older peoples’ relative health.

And yes, it speaks to a little-discussed hierarchy often found among the old, with those who are “well” – active, mobile, without significant impairments – on top and those who are sick or disabled on the bottom.

We might not like to acknowledge this aspect of aging, but it’s a reality in all kinds of settings, including nursing homes where more “with it” residents often look down on those with significant cognitive or physical problems.

More than 150 people wrote in to comment on Span’s article, which appeared in the paper and on the Times‘ New Old Age blog. Many said they had experiences of the same sort.

MJ of New York City wrote, “A similar issue came up in my mother’s CCRC. Some residents wanted people who used wheelchairs to be barred from sitting in the spacious front lobby because they thought it was ‘depressing’ to see fellow residents in wheelchairs.”

An East Coast reader using the pseudonym DemocracyNow noted:

“When my father was in assisted living, I saw this kind of discrimination practiced not by the facility, but by the residents themselves. Healthier patients would form cliques, like the cool kids in high school, and would sit at their own tables. Those who were perfectly healthy enough to engage in lively conversation, but were saddled with walkers or a wheelchair or an oxygen tank, would be banished to the outer reaches of the dining room, sometimes left to eat alone. It was a sad sight.”

Many readers called the practice of segregating CCRC residents at meals “appalling,” “disgusting,” “mean spirited” and noted that the practice appeared driven by fear.

Kate in Boston commented, “The residents in independent-living situations are looking at what can and very likely will happen to them over the next several years and it terrifies them.”

Curtis Selden Cone of Berkeley observed that the story spoke of “prejudice against the process of aging itself, which often involves physical frailty. The irony of the exclusion is that the individuals who are supporting this, may find themselves being excluded in the near future due to some disability.”

Others suggested that some kind of compromise was probably necessary.   When people are seriously disabled, unable to eat on their own, and require extra assistance, it’s probably appropriate for them to eat in a separate space, several said.  In this the case, dining rooms for more disabled residents should be similarly comfortable and inviting, they added.

Indeed, the CCRC that Span wrote about eventually let assisted living residents eat in the main dining room if they passed a functional assessment and if they had transitioned to assisted living from independent living. But nursing home residents remain excluded, as do people who move directly into assisted living when they enter the facility.

This story holds important lessons for reporters writing about aging and health:

  • Don’t assume that negative attitudes about being old and frail are held only by the young. Deeply ingrained cultural values favoring youth and vigor often remain with people through their own latter years.
  • Don’t think of the elderly as being a monolithic population. They’re not. The kinds of divisions that characterize people throughout their lives – differences of wealth, health, education, temperament and more – remain as people age and shape their preferences and experiences.
  • When you write about senior housing, be alert to the culture of senior housing facilities as well as health or safety concerns. Are these facilities inclusive? Or are healthier residents treated differently than more disabled residents? What do the people who live in these facilities say about their own situations?

Update: Elizabeth Simpson of The Virginian-Pilot published her own take on this CCRC’s controversial dining policies today.

Watch for a tip sheet with detailed information about senior housing on this site in the months to come.

‘Every day is an improvisation’ when caring for aging relatives

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

How many of us have seen problems with older relatives that we’ve looked away from, not wanting to acknowledge their seriousness or fully face the consequences?

There’s a word for this: denial. And there’s a good example of how it can affect family decision making in the current issue of the Journal of the American Medical Association. [Note: AHCJ members have free access to JAMA.]

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

It’s a personal story written by Carolyn Cannuscio, a social epidemiologist who studies aging, about her beloved 96-year-old grandmother, Nana.

After a nasty fall, Cannuscio and her mother move Nana from Florida to a Pennsylvania assisted-living facility that they had visited often and checked out with some degree of thoughtfulness.

“We grilled the staff about their services, the environment, and the nature, costs and limits of care my grandmother would receive there,” Cannuscio writes.  “We were assured by the credible marketing director on multiple occasions that this would be the last move Nana would ever have to make.”

What a reassuring promise.  If only it were true.

Cannuscio and her mom soon find that the facility is unprepared for Nana’s arrival, with “no clear plan for her daily care, no bedroom door, and – most importantly – no grab bars in the bathroom.”  What?  They didn’t make sure these plans were in place before Nana stepped on the airplane that took her away from Florida?

It gets worse – right from the start.

We quickly learned that the facility was so understaffed that Nana would be neglected on the standard care plan.  We saw residents stranded in wheelchairs in random spots in the hallway, hoping for a generous guest or a more able-bodied resident to guide them to dinner.  We then accompanied Nana to dinner ourselves and saw residents waiting unattended and unfed for long stretches, until they were addressed rudely by the harried wait staff.

Where were these alarming signs when Cannuscio and family members visited the facility in advance of her grandmother’s move?

As it turns out, they were hiding in plain sight.  Searching the Internet, Cannuscio had come across a report from the state health department that apparently showed problems with the facility’s sanitary practices.  And during a visit, she’d been taken to an apartment reeking of “cat excrement” that was home to a “disoriented, disheveled man who clearly needed more help than he was getting.”

Yet, hope prevailed:  hope that this squalid apartment was an aberration, that Nana would get the care she needed, that this difficult move would prove satisfactory in the end.

Hope such as this is entirely understandable.  But in this case, it led to denial:  a refusal to give adequate consideration to evidence that this assisted-living facility wasn’t what it was claiming to be.  After Cannuscio acknowledged that, she was distressed to discover that no federal standards govern assisted-living facilities.

In the end, however, she lays blame on “my fantasy that all of our elder care problems would be solved” with the move to assisted living.

Indeed. As older people become frail, like Nana, problems abound and there is no foolproof solution.  Not if the older person is cared for at home, not if they’re in assisted living, not if they’ve moved to a nursing home.   Daily challenges exist in all these settings and, as Cannuscio notes at the beginning of her piece, “every day is an improvisation.”

It’s our job as journalists to bring these challenges into the public realm, where they can be seen clearly and understood in context.  Our hope is that the material going up now and in the months ahead on AHCJ’s aging web resource – information about assisted living facilities and nursing homes, on long-term care and caregiving, on aging-in-place and home care – will help as you pursue these kinds of stories in your communities and make it harder to deny the very real problems that so many seniors face.

Reporter checks records, hits facility with news
of looming closure

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

After picking up new tools and techniques at Health Journalism 2011, reporter Sarah Bruyn Jones returned to The Roanoke Times and lost no time in putting it to use. Her story, on the impending closure of a local assisted living facility, came as a direct result of checking nursing home inspections. It also, if home operators are to be believed, came as a surprise.

Edward Jones, president of Ashed Healthcare Systems, which owns Monticello, said he was unaware of the state’s intentions to close the facility.

“I had no clue of any of this until you mentioned this,” Jones said when contacted late Thursday about the impending closing.

Thanks to the inspection records, Jones’ story is loaded with details like “Moldy bathrooms, poor plumbing, water leaks, crumbling walls, broken lights and roaches,” and a solid chronology of events.

At one point an inspector found that residents had been without toilet paper for at least two days. In July the building’s water was turned off because the owners had failed to pay the bill.

Patients were being given prescription medication when there was no record of a diagnosis for those drugs. In some instances, drugs that were supposed to be given weren’t being dispensed. A diabetic wasn’t receiving insulin. Another patient was only getting half the prescribed dose of medicine.

Earlier this year two residents lost Medicaid coverage after the Monticello staff member assigned to file annual renewals for the residents failed to complete the work.

Covering the Health of Local Nursing HomesSlim guide:
Covering the Health of Local Nursing Homes

This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.

AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.

AHCJ resources

Other resources