Demographies and revenues make Alzheimer’s care a growth industry with varied models.
To understand why Alzheimer’s services are growing, it helps to remember the words of Willie Sutton.
Sutton earned a living and enduring infamy as bank robber. When asked why he chose such an unusual line of work, he allegedly replied, “Because that’s where the money is.” For many eldercare operators, the dual payoff of increasing demand and enhanced revenues makes Alzheimer’s care the place where the most money is to be found.
Aging demographics, of course, explain part of the attraction. The 65-and-older population totaled 36 million in 2003, and will hit 70.5 million by 2030. Already, 4.5 million Americans have Alzheimer’s. Barring a cure, those afflicted will surpass 16 million by 2050, according to the Alzheimer’s Association. And unlike many other eldercare challenges, Alzheimer’s can linger for years. A person with Alzheimer’s will live an average of eight years — and may survive for more than two decades.
Moreover, Alzheimer’s care can be lucrative. The median price for dementia care in the nation’s largest 30 markets has reached $4,603 per month, according to the National Investment Center for the Seniors Housing & Care Industry. Operators in more upscale communities can laugh at those numbers. Consider the Silverado Senior Living home in Calabasas, CA. There, a shared room goes for $5,670 a month. Private rooms command a jaw-dropping $9,600. That doesn’t include an additional $250 monthly incontinence fee, which puts the yearly price tag at $118,000 (not counting other costs).
Jumping in
Alzheimer’s-related options have emerged in manifestations ranging from the ridiculous (new hallway signs) to the sublime (dedicated campuses).
Nationwide, about 61% of assisted living facilities provide specialized care for those suffering from dementia. Among those that do, half charge for the specialty service, according to a survey from the MetLife Mature Market Institute. Additional monthly charges range from $50 to $3,000, with $1,000 being the norm.
At the same time, more than one in three nursing homes (36%) now offer separate dementia units, according to the survey. SNF fees ranged from $10 to $25 per day.
Surveyors also found that 71% of the agencies offering home health aide services provided their staff with Alzheimer’s-related training.
“Many assisted living facilities, nursing homes and home care agencies are addressing Alzheimer’s care through specialized services, staff training and the creation of living units designed specifically for those who have Alzheimer’s disease,” said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. “The number of facilities providing dementia care is bound to grow in the years ahead,” she added.
Key areas
There is no universally accepted way to deliver optimum Alzheimer’s care, experts note. The disease is a progressive, degenerative brain disorder that gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate and carry out daily activities. Those with the illness may exhibit anxiety, suspicion, agitation, and delusions.
To help aid caregivers, the Alzheimer’s Association recently released practice guidelines that target three key areas:
• Adequate food and fluid consumption.
• Pain management.
• Social engagement.
The recommendations place an emphasis on patient-centered care — knowing the resident’s abilities, life story and preferences — and using this information to tailor care to meet the individual’s needs. Some suggestions include regular assessments of each resident, an effective care plan that is flexible and ongoing as the disease progresses, and adequate staffing to implement the plan.
The recommendations stem from a three-year study that explored staff and facility characteristics associated with quality of life for people with dementia in assisted living communities and nursing homes.
In the coming years, the Alzheimer’s Association and more than 20 collaborating organizations will release a variety of recommendations focusing on different aspects of dementia care.
To further foster better care, the Alzheimer’s Foundation of America will award an annual grant that recognizes an innovative program related to Alzheimer’s. Last year’s $20,000 award went to the Eden Alternative, based in Sherburne, NY, for its unusual staff-training program.
New players
As federal and state policymakers pursue non-institutional options, adult day care programs also are beginning to address dementia care more aggressively. In Omaha, NE, six adult day centers have sprung up in recent years to cater to the growing needs of older adults.
Nationwide, there are about 3,400 adult day centers currently in operation, but senior care advocates estimate that more than 5,000 additional centers will be needed in the next few years.
Most assisted living Alzheimer’s care centers work at creating a homelike atmosphere. Their common areas resemble the living rooms and dens of nicely decorated homes, and residents often furnish their rooms with personal belongings.
Most communities have healthcare professionals on duty at all times, but nurses’ stations are often hidden. “Business casual” has replaced uniforms, and medication carts look like dressers on wheels. For example, HCR Manor Care of Toledo, OH, designed Arden Courts to help residents who may have difficulty finding their rooms. The building is divided into four wings. Each has its own theme and color schemes. Cottage Place, for example, beckons residents with its cottage dollhouse at the entryway and rose-colored carpeting and trim. Throughout Arden Courts are “memory stations” that help stimulate residents’ thoughts.
Many nursing homes offer special care units to better meet dementia residents’ needs, and to protect residents without dementia in nursing homes and residential care facilities.
It has been estimated that more than 60% of nursing home residents have Alzheimer’s or another dementia. While estimates vary, it’s generally believed that these units have increased dramatically in recent years.
Special care
At the same time, a growing number of nursing homes are abandoning the “special care unit” moniker. This is being done partly to avoid criticism from consumer groups who have alleged the term does little to indicate the level of care being delivered. The change is also being driven by a desire to offer Alzheimer’s and dementia care settings that have a more home-like flavor.
At some facilities, the only way to tell that special services are available is to look at billing records. Other settings have special floors or wings dedicated to Alzheimer’s care. In recent years, a growing trend has been to create separate entrances, and sometimes, separate buildings on the property.
In some cases, the line gets completely blurred. Consider Manor Care, which is one of the nation’s leading nursing home chains. As was noted earlier, HCR Manor Care now offers dementia care through its Arden Courts subsidiary, which is actually an assisted living option. The buildings are designed exclusively for individuals in early to mid stages of Alzheimer’s disease, with particular attention to physical building layout, safety and decor. Modified activity and food service programs focus on preferences, abilities and most importantly, maintaining independence for as long as possible.
Fast forward
So what do emerging Alzheimer’s care services tell us about the future face of long-term care? Opinions vary. Some experts see a gradual melding of the eldercare spectrum in the years ahead. In this view, some of the old distinguishing labels likely will fall by the wayside. As proof, they point to companies such as Sunrise Senior Living, which began as an assisted living operator. The firm now has significant skilled nursing facility and CCRC holdings in its portfolio.
Other experts see firms playing to their strengths: refining their areas of expertise and carving out niches where they can outperform the competition. Still others maintain that the most successful eldercare platforms for the future have not even been considered yet.
At this point, it is impossible to know which viewpoint will win out. But the smart bets likely will side with those who adhere to Willie Sutton’s mantra, and follow the money.
