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August 2009

aging services of california

Inside: `In their shoes' by Graham Shea


Expectations of aging differ by age

What younger and middle-age adults think old age is like and what older adults report it really is can be vastly different, according to a new report from the Pew Research Center. Pew surveyed 2,969 American adults and found a wide gap in expectations versus realities of old age. When asked about some negative factors associated with aging ­ such as illness, memory loss, an inability to drive, an end to sexual activity, a struggle with loneliness and depression and difficulty paying bills ­ older adults reported experiencing them at lower levels than younger adults expected. At the same time, however, older adults report experiencing fewer of the benefits of aging than younger adults expect, such as spending more time with their family, traveling more for pleasure, having more time for hobbies, doing volunteer work or starting a second career. (excerpted from Selling to Seniors, 7-1-09) years of ER medical records. Nearly 9 out of 10 of the injuries involved walkers, rather than canes. Officials with the Centers for Disease Control and Prevention said their recent study shows that doctors should take more time to better fit patients with walking aids and to teach people/patients how to use them safely. (excerpted from the Associated Press, 6-30-09)

`Frequent fliers' hospital bills sky high

Too many older adults fall into ERs

U.S. health officials say more than 47,000 older adults end up in emergency rooms each year from falls involving walkers and canes. That's almost 3 percent of all falls among people 65 and older. Government researchers came up with the estimate by looking at six


August 2009 News Report ....................................................................................... 2 Feature: `In their shoes' .........................................................3,12-14 Residential Care Report ................................................................... 4 Housing Report.................................................................................. 5 Skilled Nursing Report .................................................................... 6 Home and Community Care Report ............................................. 7 Resident Report ................................................................................. 8 Aging Services Report ........................................................ 9-11, 15

Doctors call them frequent fliers. They are the patients who leave the hospital, only to boomerang back days or weeks later. They have become a front-burner challenge not only for hospitals and doctors but also for those trying to reign in rising costs. Typical reasons for readmissions for older adults and those suffering from chronic diseases, who account for 75 percent of healthcare spending, include high rates of medical errors and hospital-acquired infections; lack of communication between hospitalists and regular physicians; trouble getting a prompt doctor's appointment after discharge; missed referrals for home healthcare; and poor coordination and medication management during transitions from hospital to home or nursing home. Dozens of promising initiatives are underway, but sweeping changes are needed in how healthcare is delivered and how hospitals and doctors are paid ­ sensitive issues that confront Congress and the medical industry in the debate on overhauling the health system. (excerpted from Kaiser Health News, 6-30-09)

Survey dispels more aging stereotypes

A new study is challenging some of the stereotypes associated with aging. Ten percent of U.S. centenarians reported sending emails, 12 percent reported sharing photos via the Internet and 4 percent downloaded music online. The survey demonstrates that growing old does not preclude keeping abreast of new technology. Evercare, one of the largest care coordination programs in the country, commissioned the survey of 100 centenarians. The company said it believes the results provide further evidence that lifestyle, rather than genetics, primarily determine a person's longevity.

Copyright 2009 by Aging Services of California. All rights reserved. The agenda logotype is a trademark of Aging Services of California. Byline articles express the opinions of the authors and do not necessarily reflect those of Aging Services of California and its members. Advertisements within agenda do not imply Aging Services of California endorsement of the product or service. Permission is granted to reprint articles and reproduce pages (in same, unaltered format) for educational, non-commercial purposes only. A copy of any publication including a reprinted agenda article should be forwarded to Aging Services of California. The agenda Editorial Board encourages submission of original articles for consideration. Subscription to agenda is paid through Aging Services of California membership dues. Third-class postage paid at Sacramento, California.

aGinG services of california


Advocating Quality Senior Living and Care

agenda is the monthly newsjournal of:

Aging Services of California

1315 I Street, Suite 100, Sacramento, CA 95814 tel. 916-392-5111 · fax 916-428-4250 · Aging Services of California represents more than 400 nonprofit providers of senior living services ­ including affordable housing, continuing care retirement communities, assisted living, skilled nursing and home and community-based care. Aging Services of California's advocacy, educational programs, communications and other resources help its members best serve the needs of more than 100,000 seniors. Founded in 1961, Aging Services of California is celebrating its 48th year of public service. "Aging Services of California," the line "Advocating Quality Senior Living and Care" and the "homes and heart" logo are registered servicemarks of Aging Services of California.


Editor: Stuart Greenbaum Graphic Design: Darren Lindsey Contributing writers: Jack Christy, Lori Costa, Eric Dowdy, Jan Guiliano, Christin Hemann, Rick Taylor About the cover: "For the Record: Too Many Charts." Photograph by Stuart Greenbaum.


August 2009


Graham Shea


wo therapists helped me to settle in as I gripped the leather arms of the wheelchair. I had never stayed in a nursing home before, and the thought of finally having to was uncomfortable to say the least. What indignities and discomforts would I undergo? Would they take care of me, or ignore me? Was I

Graham Shea is a licensed administrator for Kennon S. Shea & Associates, a San Diego based management company, and is one of the fourth generation of Shea family healthcare providers. He graduated magna cum laude from Pepperdine University and began working for KSSA in 2007, one year after his father Kennon Shea passed away from cancer.

August 2009

handing over control of my life, or would I be able to make my own decisions? Eyes stared at me as I rolled slowly down the hallway. Everyone loomed over me, except the others in wheelchairs, whose ranks I was now joining. I felt helpless already. In the past I had thought about what it would be like to be in a nursing home ­ perhaps more than most people do ­ but this was the real thing. It was my own doing that got me there. I started a nursing home Administrator-In-Training program in January of 2007, with no previous healthcare experience. I knew I also had a lot to make up for being younger than most of the employees. I decided to make up in first-hand experience what I lacked in work experience, and so I arranged with the administrator, my preceptor, to check myself in as a resident for 24 hours. It was a far cry from an average length of stay, but better than nothing. Almost as soon as the suggestion was out of my mouth I regretted saying it. Yet, almost as soon continued on page 12



RESIDENTIAL CARE REPORT Legislation addresses CCRCs oversight and nonprofit status

closely with Partington in 2001 when he was appointed chief of the division's Continuing Care Contracts Branch which oversees the state's CCRCs. "I know Ben has been a strong leader and an excellent representative of the department's interests over the years," said Joanne Handy, Aging Services' president and CEO. "Aging Services' members will truly miss Ben's collaborative and open approach to working with providers. His departure is a big loss on many levels."

Assembly Bill 1044 (Jones, D-Sacramento) was amended in late June to include provisions that, if it became law, would have an extremely detrimental effect on continuing care retirement communities in California. In addition to moving the Continuing Care Contracts Branch's financial oversight functions to the state Department of Insurance, the bill gives the insurance commissioner the ability to set the rates for monthly fees and services, impose new and alter existing reserve requirements, and force CCRCs to comply with Insurance Code requirements. The amendments drew sharp criticism from many stakeholders groups. Aging Services of California continues to oppose AB 1044 on the grounds that the bill is unnecessary and complicates oversight by making two governmental agencies responsible for enforcing a single contract. AB 1169 (Ruskin, D-Redwood City) was recently amended to simply require that providers state how CCRC funds will be used in furtherance of their nonprofit missions. The requirements that would have restricted funds to a single corporate entity or alter reserve requirements have been deleted from the bill. For the latest information or a copy of either bill or to be added to the list for legislative updates, contact Eric Dowdy at [email protected]

Evaluator Manual Updated to Reflect Renumbered Regulations

CCLD gains new deputy director, loses program administrator

Jeffrey Hiratsuka was recently named the new deputy director of the Community Care Licensing Division, replacing Jo Frederick. Hiratsuka has been the chief of the Central Operations Branch for almost eight years and has more than 36 years of state government experience. He has been in management for the past 15 years with the California Department of Social Services. Aging Services of California looks forward to continuing the productive working relationship that it currently enjoys with the department. In other news, Ben Partington, the program administrator of CCLD's Adult and Senior Care program, announced his retirement effective this September. Partington has worked with the Community Care Licensing Division since 1984 in various capacities including licensing program analyst and policy manager. Aging Services' members had the opportunity to work

The California Department of Social Services Community, Care Licensing Division revised its RCFE Evaluator Manual to match the renumbering and re-titling of the RCFE regulations. Additionally, several policy sections were updated to include Regulation Interpretations of the following sections: · The Personnel Requirements section (Page 65, Section 87411(c)(1)) was amended to clarify that employees at facilities who are currently certified as Standard First Aid Instructors may train other facility staff if they are certified through the American Red Cross or other authorized agency. · The Incidental Medical and Dental Care Services section (Page 90, Section 87465(h)(5)) clarifies that medications can be set-up prior to self-administration if less than 24 hours. Other requirements are also included. · The Admission Agreement section (Page 95, Section 87507(c)(3)) was amended to include the following statement regarding deposits: "Deposits are prohibited in residential care facilities for the elderly. A licensee may not charge a resident first and/or last month's rent as this is considered a deposit." · The Hospice Care for Terminally Ill Residents section (Page 108, Section 87633) has been amended to include additional guidance on "bedridden" residents and prepouring of medications. · The Evaluation Visit section (Page 114, Section 87756) has been amended to include procedures for displaying licensing reports, completing the Facility Evaluation Report (LIC 809) or the Complaint Investigation Report (LIC 9099). The full Evaluator Manual can be downloaded on the CCLD website at

The Residential Care Report for agenda is prepared by Eric Dowdy, associate director of public policy, for Aging Services of California. He can be reached at 916-469-3376 or [email protected]



August 2009


HUD delays implementation of handbook change

The U.S. Department of Housing and Urban Development decided to delay implementation of changes to Chapter 6 of the 4350.1 Handbook until September 29, 2009. This chapter "Comments from field was revised in personnel and others have assisted in pointing out items June and deals for clarification. A few items specifically with will probably be the subject management of an eventual change in reviews. According the Handbook text. The to a memo from department wants to ensure that everyone has adequate headquarters, opportunity to review the "Comments from text in detail and determined field personnel the additional time will not and others have significantly impact HUD assisted in pointing program oversight." out items for clarification. A few items will probably be the subject of an eventual change in the Handbook text. The department wants to ensure that everyone has adequate opportunity to review the text in detail and determined the additional time will not significantly impact HUD program oversight." The memo also encourages stakeholders to submit questions and comments to HUD (via [email protected]) by no later than August 20, 2009. It is important to include a subject line that reads "Chapter 6, 4350.1" to ensure that appropriate and timely delivery. A copy of the memo can be downloaded by visiting .

model leases can be found by visiting http://www.hud. gov/. HUD also updated a number of forms with a new OMB expiration date (5-31-11). Because the only change appears to be the expiration date, providers need only take action if these forms are being used direct from HUDClips. If, however, the forms used are generated by system software, OMB expiration dates are not required ­ so no action is needed. Additional information on these forms can be found by visiting

AB 123 to Governor's desk

Assembly Bill 123 (Portantino, D-Pasadena) cleared the state Senate and is now on its way to the governor's desk. The bill, which is sponsored by Aging Services of California, would make it easier for seniors in certain types of affordable housing to access needed support services, made its way through the legislature without receiving a single "no" vote. In fact, the bill was placed on consent early on and cleared the Assembly and Senate in near-record time. Association staff met with the governor's office and formally requested that he sign the bill into law. He has until October 11 to do so.

Industry meeting well attended

Model leases translated into several languages

A number of updates to several occupancy-related documents have been made by the U.S. Department of Housing and Urban Development. Specifically, the multifamily model leases are now available in 11 different languages (keep in mind that these model leases are to be used only for information purposes ­ to help the resident understand their rights and obligations ­ and are not to be signed as executable documents). Additional information on the translated

August 2009

A recent meeting between Aging Services of California's Southern California housing members and the Los Angeles HUD Office was well attended and provided an opportunity for dialog on a number of substantive issues. Though the agenda was dominated by the recent changes to Chapter 6 of the 4350.1 Handbook, there was also discussion around the process for including service coordinators as an eligible expense in PRAC budgets. The L.A. HUD Office is working on guidance to clarify this process and hopes to have something definitive within the next month. The next industry meeting will likely be scheduled for late September. Watch association communications for additional information.

The Housing Report for agenda is prepared by Rick Taylor, associate director, Housing for Aging Services of California. He can be reached at 916-469-3378 or [email protected]



SKILLED NURSING REPORT Aging Services' members receive Excellence in Action awards CMS releases final changes to hospice regulations

My InnerView's 2007 Excellence in Action awards honored four Aging Services of California members who have demonstrated overall resident and family satisfaction levels that fall within the top 10 percent of the research company's customer database. The award recognizes those nursing homes that have made a commitment to continuous quality improvement and have successfully made quality a priority to better serve their customers' needs. Only 299 nursing homes throughout the country received this year's award. My InnerView maintains the largest private database of customer satisfaction metrics; and provides resources to more than 7,400 senior care providers across the nation. The exemplary facilities are Canterbury Woods in Pacific Grove, Los Gatos Meadows in Los Gatos, San Francisco Towers in San Francisco and Spring Lake Village in Santa Rosa.

In its first revision of the hospice regulations since 1983, the Centers for Medicare and Medicaid Services included specific language concerning the rights of patients. These rights include the right to participate in the treatment plan; right to effective pain management; the right to refuse treatment; and the right to choose his or her own physician. In addition to the patients' rights section, the new rules also include requirements that the patient be initially assessed within 48 hours of electing the hospice benefit; have a drug profile and a consultant such as a pharmacist to ensure drug needs are met; and a provision allowing intra hospice contracts for services under certain circumstances. The rules removed the provision that an inpatient facility only providing respite care have an RN on duty 24-hours-a-day. Additionally, the new rules included a new condition of participation that refers to hospice providing care in a skilled nursing facility. Providers who have contracts with hospice providers should review the new hospice conditions of participation at CFCsAndCoPs/05_Hospice.asp.

CDPH regulations nearly final

The California Department of Public Health convened two stakeholder groups to gain input concerning regulations being developed to implement Health and Safety Code section 1418.91. This section requires all long-term care facilities to report allegations and suspicions of abuse. Without further guidance as to what constitutes an allegation or suspicion, providers are left in a quandary. Providers have asked the department for further clarity in the regulations to ensure that the reporting system would function as intended by the state Legislature. The department is in the process of reviewing the input of stakeholders and formalizing its policy decisions. In addition, admission agreement and disaster preparedness regulations are nearing completion.

How to create the home in nursing home

The Pioneer Network and the Centers for Medicare and Medicaid Services jointly sponsored an unprecedented conference on the environmental aspects of culture change and person-centered care. More than 500 consumers, regulators and providers attended the sold out conference. The focus on privacy, household models and home environments addressed issues that many providers must face when trying to make environmental changes. In 2009, Life Safety Code requirements are scheduled to be reviewed. Providers hope to see more flexibility in order to address the needs of the residents. To view conference presentations, check the Pioneer Network website at www.

CMS, Region IX holds quarterly quality improvement call

Sleep apnea underreported in nursing homes

The Centers for Medicare and Medicaid Services held its quarterly quality improvement conference call for state survey agencies, QIOs and provider associations. The purpose of the call was to share information and strategies for continued quality improvement in skilled nursing facilities. All states reported on their collaborative efforts to improve quality, especially in the areas of pressure ulcer and restraint reduction. Arizona, through a Civil Money Penalty grant, is working on an enforcement/quality improvement model which will yield some best practices. CMS announced that it is in the preliminary stages of developing a culture change meeting for surveyors sometime in 2009, if budgetary constraints do not put a hold the plans.

An American Association of Homes and Services for the Aging study found in a sample of medical records of nursing home residents that only one-half of 1 percent had sleep apnea documented in their medical records. The findings are in contrast to other resident studies which show a high rate of sleep apnea in nursing homes. Sleep apnea has been linked to bladder control, agitation and cognitive function. Although probably seen as a low priority on the part of physicians, treatment of the sleep disorder may be relevant to other treatment goals.

The Skilled Nursing Report for agenda is prepared by Lori Costa, regulatory and clinical consultant for Aging Services of California. She can be reached at 916-469-3377 or [email protected]



August 2009

HOME AND COMMUNITY CARE REPORT HCBS legislation building momentum

valid, consistent and reliable dates to establish the new ADHC reimbursement rates. The bill was amended on June 1 to allow the department one year to implement the new rate methodology; the original legislation required three years. To receive email updates on HCBS legislation, contact Christin Hemann, public policy analyst at [email protected]

Aging Services of California's Home and CommunityBased Subcommittee identified a wide range of HCBS related bills that will have an impact on providers in California. The following partial list identifies key bills the association has been tracking this year: AB 324 (Beall, D-San Jose) is a measure that would require the California Department of Aging to annually update the Elder Economic Security Standard Index, referred to as "the Elder Index." The Elder Index is a new tool that accurately quantified the annual cost of meeting basic needs for retired, older adults in each California County. Currently, policymakers measure poverty using the Federal Poverty Line, a source which dates back to 1963. AB 324 would provide a better and more current measure of poverty to plan for the needs of the growing aging population. AB 369 (Yamada, D-Davis) relates to the implementation of a moratorium on the certification and enrollment into the Medi-Cal program of new adult day health care centers. This bill would add a stateowned and operated property, for which facility planning began during or before 2002, that was funded by state bonds and federal grants to serve veterans who reside in California to the list of applicants that are not subject to the moratorium. SB 38 (Alquist, D-Santa Clara) was introduced to enact a "Silver Alert" program in California, which is modeled after the Amber Alert program now present in all 50 states, and is aimed at protecting an increasing number of older adults with cognitive impairments who become lost. The bill was significantly amended in May to address concerns that the "Silver Alert" program could potentially take current resources away from the Amber Alert program in California. The author addressed the issue by requiring the California Highway Patrol to incorporate appropriate alert measures in developing their policies and procedures after certain missing senior requirements have been met. The bill would also require the law enforcement agency that initiates the missing senior person alert to inform the general public upon the location of the missing senior person. SB 117 (Corbett, D-San Leandro) is a response to SB 1755 (Chesbro) in 2006 that incorporated reforms to the Adult Day Health Care program. Currently the state Department of Health Care Services has been unable to meet the current deadlines required in SB 1755 for developing the new rate methodology. SB 117 provides an additional one year for the implementation of the new rate methodology for ADHC programs. The additional time provided in SB 117 could help to ensure that the state has

August 2009

Costs for routine care too much for some seniors, report finds

A new UCLA report finds that costs for routine care ­ including meal preparation, housework and personal hygiene exceeded the annual income for Los Angeles County seniors who live alone. The news comes as the state is considering drastic cuts to its In-Home Supportive Service program. Under the governor's proposal, 175,000 of the 180 low-income seniors in the county who receive financial help from the state could have to move into institutional care, or have to pay for their own in-home care. Even older adults who aren't considered low income fall short of the cost of paying non-medical caretakers, who make $8 to $12 an hour. In Los Angeles County, older adults spend $17,348 a year for 16 hours of routine work by caretakers per month. Meanwhile, the median income for county residents over 65 is just $17,029. When adding costs of food, rent, medication and other expenses, these residents fall about $22,827 short each year, the data shows. (excerpted from, 6-7-09)

Federal legislation would allow Medicare to cover adult day care

Proposed legislation authored by Rep. Linda Sanchez (D-Lakewood) could make taking care of a sick adult less expensive. Under this new program, Medicare beneficiaries will be able to receive more services and hours of lower care for a lower, all-inclusive rate than currently available through many providers. Services covered in the bundled adult day services rate would include: nursing, physical, occupational and speech therapy, social services and personal care, as well as meals, transportation and recreational activities. The Home and Community Care Report for agenda is prepared by Christin Hemann, public policy analyst for Aging Services of California. She can be reached at 916-469-3372 or [email protected]




Three times 100, plus 19 years, equals major celebration

Three centenarians with 48 years of residency helped Baywood Court Retirement Community in Castro Valley celebrate its 19th anniversary. Centenarians Esther Irey, Cal Rule, and Gaston Dorisse helped Baywood Court residents and staff celebrate the anniversary, which featured two days of "Olympic" activities that commenced with a ceremonial torch passing walk around the campus. Festivities also included banana split sundaes, Wii games, golf putting, marshmallow shoots, and 25 other activities of skill Baywood centenarians, and fun. from left to right: Centenarian Cal Rule noted, "I'm Gaston Dorisse, Esther Irey, and in my 19th year at Baywood, almost Cal Rule. a fifth of my life, an important part. Baywood is a good place for anyone who wants lots of good companionships." Esther Irey and Rule were among the "Pioneers" who moved to Baywood in its first summer in 1990. Gaston Dorisse joined them in 1999. Staff members Marion Jeffers, Lisa Ray, Macario Rosas and Barbara Cullinane also celebrated their 19th anniversaries at Baywood.

Recession puts big crimp in retirement communities

In-home care costs exceed income for many Californians

In Los Angeles County, being disabled can cost a year's income. That's because the annual cost of in-home care services for older adults living alone is now $319 more than this group's median income of $17,029. Combine long-term care expenses with other basic expenses, such as food and rent, and an older adult living alone in Los Angeles will need twice the median income to survive, according to new data released this June by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development. In all 58 California counties, long-term healthcare is far out of reach for the state's most vulnerable citizens: older adults living alone who are disabled. In fact, in all counties long-term care paired with basic living expenses far exceeds median income. Approximately 973,000 California seniors live alone. Of these, 50 percent do not have enough income to meet basic expenses, as defined by the Elder Index. (excerpted from Medical News Today, 6-20-09)

Many older Americans are finding that the economic meltdown has put a big crimp in their plans to move into retirement communities. Aside from cracked nest eggs, falling home prices and weak homebuying demand have also forced many older adults to stay put rather than make the transition. That's because they often pay for retirement-community slots with funds from the sale of their existing homes. Vacancies rose sharply in the nation's retirement communities last year, according to the National Investment Center for the Seniors Housing and Care Industry. Long waiting lists were once the norm, but no more. The NIC MAP Data Analysis Service tracks business conditions in retirement facilities in the nation's 31 largest metropolitan areas, and includes only professionally managed, market-rate facilities with at least 25 units. It released data on independent living units, assisted living facilities, and continuing care retirement communities, which include both independent and assisted-living units. Information about nursing homes will be released at a later date, a spokesman said. Only a handful of the metro areas followed by NIC MAP avoided declines in occupancy rates last year. Even so, stated purchase prices and rental rates were relatively stable. However, as the NIC spokesman noted, weak market conditions have caused widespread discounting and other special lease and purchase arrangements, including lengthy payment deferrals. These provisions are not reflected in the stated price levels. Consumers can get great deals these days, but they should be careful to avoid communities with financial problems that could jeopardize maintenance and amenities. It's also smart to take a look at a facility's financial documents before making a decision, and avoid places that will not provide confirmation of their financial stability. The Resident Report for agenda is prepared by Stuart Greenbaum, editor and public relations counsel to Aging Services of California. He can be reached at [email protected]



August 2009


Boomers forced to redefine retirement

America's 77 million boomers grew up during a time of cultural change, and now are being forced to redefine retirement at midlife. The generation faces an economic storm: The Wall Street meltdown trampled their retirement nest eggs more than any other group. After losing jobs during what they thought would be some of their peak earning years, many are struggling to get back into the workforce. Health care costs are rising, and declining home values mean they might not The reality is sinking in, be able to count boomers, born from 1946 to on home equity 1964, are planning to work longer, save more money to guarantee and spend less, to reach any an easier semblance of the retirement retirement. they once envisioned. The confluence of events has an even bigger impact on a subset of boomers known to analysts as the Sandwich Generation. Those boomers are putting money toward their children's college education and their aging parents' long-term care, as well as their own retirement savings. The reality is sinking in, boomers, born from 1946 to 1964, are planning to work longer, save more money and spend less, to reach any semblance of the retirement they once envisioned. According to AARP: · 35 percent of those ages 45 to 54 have stopped putting money into their 401(k), IRA or other retirement accounts. · 25 percent said they have prematurely withdrawn funds from their retirement accounts. · 56 percent have postponed a major purchase. · 24 percent have postponed plans to retire. While the economic crisis has forced boomers to rethink retirement, there may be a positive result. The financial crisis has forced them to look ahead. In reality, they will live much longer and be healthier than their parents' generation. And retirement may be filled with much more than playing golf or cards. (excerpted from USA Today article by Christine Dugas, 6-16-09)

August 2009

Aging Services of California Region meeting calendar

Delta Region July 23, Thursday, 10 am - noon Asian Community Nursing Home ­ Sacramento "Health Care Reform: Divided We Fail" Presenter: Joanne Handy Santa Rey Region August 13, Thursday, 10 am - noon Los Gatos Meadows ­ Los Gatos "Health Care Reform: Divided We Fail" Presenter: Joanne Handy Golden Gate Region August 28, Friday, 10 am - noon On Lok ­ San Francisco "Always Active" Presenter: Dr. Chris Thompson

Guiliano appointed to HSAG board

Janice Guiliano, director of education and events management for Aging Services of California, was accepted to the Health Services Advisory Group of California, Inc. Board of Directors. In August 2008, the Centers for Medicare and Medicaid Services chose HSAG as the QIO for California, the third subsidiary, known as HSAG in California. HSAG is working under the latest three-year federal Medicare quality improvement contract, the ninth Scope of Work.

Jan Guiliano

Aging Services hosts healthcare service day event in Davis

Aging Services of California recognized President Obama's National Health Care Day of Service, June 27, by hosting an information booth at the city of Davis Farmer's Market. Visitors collected materials on aging services, caregiving and AAHSA's long-term care solution. More than 200 volunteers and healthcare providers across California also participated in the president's day of service by hosting events in their communities. Aging Services' members interested in scheduling an event or visit at their community by a national, state or local government official should contact Christin Hemann at Aging Services at [email protected] 916-469-3372.




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700 West Center Street, Visalia, CA, 93291 · 800-745-3947 ·

CA License #0797015



August 2009


Nonprofit subsidy reduces phone expenses

In an effort to continue streamlining costs, Aging Services of California recently reduced the organization's monthly phone charges by 50 percent, a savings of approximately $5,000 annually, by applying for the California Teleconnect Fund Discount. The association's Approved Vendor, Salient Networks, recommended that both Aging Services and members take advantage of this state telephone subsidy available to a range of 501(c)3 organizations. In reviewing Teleconnect Fund public records, it appears that very few Aging Services members are taking advantage of this available discount. This cost-cutting opportunity will not have any corresponding reduction in services provided to your organization. There is no cost to apply and the savings are noticeable. For more information on saving through the California Teleconnect Fund discount, or to have your bills audited for other potential savings, contact Cindy McCreary at Salient Networks at 760-930-2634.

ank you to Aging Services of California's Premier Partner Associate Members! ese companies provide notable financial support and volunteer time to Aging Services to enhance the mission, goals and service provided by Aging Services of California and our Members. Support the companies that support you.

Cain Brothers

Hanson Bridgett LLP

HPSI Group Purchasing

Lewis & Associates Insurance Brokers


Purchasing consultant now available for affordable housing

Salient Networks

Aging Services of California and HPSI Group Purchasing, an association Approved Vendor, have developed a resource for affordable housing members to contact for purchasing needs. HPSI, a California based company, has created a dedicated staff person within their organization to specifically serve Aging Services' affordable housing members. Affordable housing administrators can now access this free support service to reduce time spent on collecting bids and managing purchases. The purchasing consultant becomes a single point of contact for members to access a wide variety of resources in areas such as plumbing, electrical, hardware, housekeeping supplies, office supplies and more. Using the purchasing strength of HPSI, the purchasing consultant will help members secure the best pricing available. To begin using this free service, contact Ric Gille at HPSI at 800-223-4774, ext. 210 or [email protected]; or Stephanie Doute at Aging Services at 916-469-3364 or [email protected]

August 2009


Sodexo Senior Services

Stone Tapert Employee Benefits & Financial Services

Ziegler Capital Markets

And welcome to our newest Premier Partner Member

Consonus Rehab Services



in their shoes continued from page 3 as I regretted saying it I realized why it was so important that I do it. I was living hypocrisy by expecting our residents to feel comfortable and at ease when, in their shoes, I myself could not. Rolling past rooms and carts and other residents, I felt like Jane Goodall descending into the jungles of Tanzania to live with chimpanzees. But why was a brilliant study like that being done for chimpanzees, and not my own human race? To make the experience as real as possible, Almost as soon as the my preceptor suggestion was out of my mouth I regretted saying and I worked it. Yet, almost as soon as I on developing regretted saying it I realized a complete why it was so important that medical profile I do it. I was living hypocrisy for me. The more by expecting our residents to feel comfortable and at ease pretending the when, in their shoes, I myself staff had to do, could not. the less I would feel like a real resident feels. In summary, I was a 79-year-old man with a hip fracture, slight dementia and diabetes. Though I had walked down the same halls thousands of times before, I suddenly felt like Dorothy in Oz. Everything seemed different. Luckily the staff were very good with me overall. Maybe they were better with me, being one of their overseers, than they were for some other residents, but if so that gave them something to think about without my having to even say a word. One of the first things I got to do to make myself at home in my bed was get stripped down for a skin check. My mental gears were already spinning like a runaway locomotive to think of how that process could be made less unpleasant, and I was sorry to admit it had never crossed my mind before. My loss. It was unpleasant. Then someone came in to give me an intimidating stack of legal documents to sign. I took her word for everything being what she said it was, 12 but asked for a copy anyway. When I began to read it, I noticed some pages were out of order or upside down, or maybe even missing. Two alarms went off in my head ­ the nursing home resident alarm, and the AIT alarm. The first one said, "How can they tell you what you just signed if they don't even look at it?" The second said the same thing. I had looked at it, but not with a fine-tooth comb, and I realized there were probably many other things that were still flying under my limited radar. I pulled out a pen and started scribbling in a notebook I had been wise enough to bring. To think on the positive side, I started traveling mentally to all the nice hotels I had stayed at, and thinking about what things were nice in those places that would be nice here and now. At one hotel there was a hand-signed letter left for me, welcoming me by name and saying they had been expecting me. It made me feel in very capable hands. Feeling vulnerable and nervous, I jotted another note in the book about welcome letters. Lunch came before long. But what was for lunch? The pink plastic lid popped off in front of me to reveal linguini with clam sauce. I felt like a drum roll would have been appropriate. I couldn't remember the last time I had been served food without knowing ahead what it was, and I cared little for the surprise. I vowed to always tell my residents before popping the lid what meal had been prepared. On my bed rail hung a container half-full of urine, since I was immobile. Another, louder, AIT alarm went off. I was used to washing my hands 1,200 times a day, and suddenly there was food, urine and no sink or soap ­ another thought that had never crossed my mind. We later began distributing alcohol hand wipes with meals. One of our best nurses came in to update me on my status. She told me about what information they were waiting for, what they could not do till they got it and what I would not be able to do as a result. (The busy administrator was my "physician.") I realized she was doing her job well, but for some reason I didn't like how I felt when she told me. She could have told me what she was doing, and was prepared to do if more action was needed. The


August 2009


whole idea of how we phrase things was also too subtle to have shown up on my radar. But as a resident, it mattered to me as much as anything else. In the long hours of the afternoon, boredom began to consume me. There was once an ambitious resident who decided to keep a list for me of how I was failing as a nursing home administrator to run things as they should be run. I was actually pleased to get the feedback. Though his condition was fairly serious, near the top of his list of concerns was a small patch of brown grass outside his window that had apparently been deficiently fertilized. The irony of grass being one of the man's greater afflictions amused me. But as the clock ticked in my own room and nothing happened, something suddenly occured to me. I found myself grumbling for the tenth time at how a chip in the bathroom door looked very tacky. A light in my brain went on. I could finally understand why the grass mattered so much. The chip in the door was about the entirety of my sensory experience for several hours, and that made it nearly unbearable, like Chinese water torture. The wall behind me might as well have not existed, but the wall in front of me became low-hanging fruit for an administrator who wanted to improve his residents' quality of life. Few parts of a facility matter as much as those precious square feet a resident stares at for weeks or months if not years. One of the most valuable things I learned from the experience was that being told or reading about how to give good care would never be enough to understand my residents. Sharing just a few of their experiences gave me a whole new world of understanding. Before, I had had little sympathy for residents who didn't get what they never asked for in the first place. Logically, asking was the clear solution. But from my bed, there were many

Nursing home sleepover open architects' eyes

Even in a wheelchair and with sweat pants and T-shirt, David Dillard didn't look like the other nursing home residents. He was 25 years their junior, and he seemed much more curious about his surroundings than anyone else, chatting up the staff and residents and paying careful attention to door widths, hallway lighting and window heights. Dillard wasn't at the Pilgrim Haven skilled care center in Los Altos, California, because of an illness, injury or longterm disability. The 58-year-old Dallas architect of senior living communities was there to live the life of a nursing home resident for 24 hours. "It gives you a new respect for the residents," he said. "Living with them deepens your passion for your work, and it opens your eyes to some practical ways to improve a building's design." Dillard believes so fervently in the value of such nursing home stays that he's required all senior living architects at his firm, CSD Architects, to pack their overnight bags and join him on the Sleepover Project this year. This may be a first in the architectural profession, said Ingrid Fraley, head of the American Institute of Architects' Design for Aging advisory group. "David has raised the bar with his commitment to understanding what nursing home residents face," she said. "There's nothing like wheeling through a lobby with only a sheet over you on your way to the shower to understand the importance of design. Sometimes, architects forget how people get from Point A to Point B." Reality check About three dozen CSD employees will fan out across the country this summer and check in at nursing homes, dementia care facilities and assisted living communities that have agreed to participate in the project. Dillard, president of CSD, kicked off the sleepovers in April 2009 when he became a roommate of an Alzheimer's patient at the Los Altos continuing care retirement center. The Dallas architect has designed dozens of senior living communities over the last 20 years, but Pilgrim Haven's administrators had promised to treat him like any other resident. To help him appreciate his fellow residents' infirmities, the staff placed Dillard in a wheelchair, taped his fingers together to simulate arthritis and gave him a color-coded wristband to alert caregivers that he was prone to falling. Revelations Dillard intends to take the lessons he and his colleagues learn from their stays and compile the observations into a journal they can consult as they design other nursing homes, dementia care facilities and assisted living residences. Aside from the benefits to his business, Dillard said he has a personal stake in the project. "What we design today will be what my generation inherits in its old age. That's a big incentive to do better." (excerpted from an article by Bob Moos, The Dallas Morning, 5-27-09)

August 2009




things I would have liked to have had but was either too timid, or already too upset to bother asking for. Or perhaps I felt I couldn't ask because it wasn't "how things were done." The process of institutionalization was already beginning in my first 24 hours. I share what I learned from the experience not to give people tips on what to change about care, but to challenge them to take the same approach and to step into the shoes of their residents. I believe even the veteran care provider I found my bonds with will learn residents strengthened during many helpful my time in their shoes. After things from this getting cleared to drive a approach. There wheelchair on my own, I inched down the hallway to is little debate say hello. that we are entering a time when providers and caregivers will have to think increasingly outside the box. I see this approach as a way to cut directly to what matters, because if it matters to you, it probably matters to them. There were also many benefits to the undertaking I had not anticipated. My attitude toward residents permanently changed. I went from having sympathy to empathy, and a much greater quantity at that. It wasn't a chore; it was suddenly very easy to be understanding. My understanding of comfort changed from something primarily physical to a conglomeration of senses, feelings and mentalities. The whole process was both helpful and refreshing for our staff. With so much training tending to be either punitive or in the form of rushed in-services between shifts, a positive learning opportunity that also boosted morale and made everyone truly think about dignity and care was invaluable. Nobody ever forgot the experience. I found my bonds with residents strengthened during my time in their shoes. After getting cleared to drive a wheelchair on my own, I inched down the hallway to say hello. At first they were terribly concerned that I had hurt myself, but after being told what I was doing they became excited and very appreciative. Mrs. R. and I stayed up after dinner 14 looking at her old photos and sharing stories. It was the grand moment of acceptance into the wonderful chimpanzee colony. Most people ask me why only 24 hours. What I advocate is the experiential approach of learning for healthcare, and that can take the form of anything from using a facility toothbrush for a day to going undercover and staying in a facility for a month. Receiving care obviously takes time and real staff resources. I guarantee they will be well-spent, if the process is taken seriously and done with an open mind, and if the findings are followed through to results. People also ask if I was given a shower. It may be surprising, but I was not. I know of some providers who chose to be given showers but wore swimming suits. Practically speaking, one is putting one's staff and coworkers in as much a position of vulnerability as oneself when being cared for in one's own facility, and I believe that should be taken into due consideration. I'm sure the experience would have been beneficial. The value of this learning approach is in its intensely personal nature. When debriefing our staff, I opened up a box of hospital gowns and told them each to put one on. There was an awkward silence in the room until one person had the courage to ask if they had to take off their clothes. I said yes, and an even more awkward silence followed. Finally, I relented and said they could just put them on over their clothes. But the point was clearly made that our residents had to do something none of us wanted to do. It should be pointed out that the aging process can't be pleasant all the time, even when care is everything it should be. To pretend otherwise robs those we care for of their dignity in suffering and the compassion we owe them. There will never be a way to completely end the difficulties and discomforts of the aging, but we have the duty to do what is in our power. I challenge you reading this article to experience something your residents must live with. You will not regret it. If the first thing you think of sounds too awkward or uncomfortable, ask yourself why you wouldn't be willing to do it, and why someone else must instead.


August 2009


Public Policy Conference

Dates: February 8-10, 2010 Location: Sheraton Grand Hotel, Sacramento Watch for details online at

Annual Conference & Exposition: Communities: Inside Out

· Emergency Call ­ What are the New Options Available to Increase Response Time, and Improve Nurse Productivity and Mobility? October 14, 10 a.m. ­ 11 a.m. · Integrating Legacy Systems and Building a 5 Year Strategic Technology Plan ­ You Don't Have to Replace Everything. November 18, 10 a.m. ­ 11 a.m. · Improving Nurse Mobility ­ Increasing Resident Satisfaction. December 16, 10 a.m. ­ 11 a.m.

Alternative Education Opportunities

Dates: May 3-5, 2010 Location: Westin Hotel Long Beach and Long Beach Convention Center Watch for details online at

Last chance to register:

Freestanding Retreat

Dates: August 21-22, 2009 Location: Mission Inn, Riverside, CA

Service Coordinator Conference

Date: August 27, 2009 Location: Embassy Suites Hotel, Walnut Creek For program description and registration information on both conferences, check the Aging Services website,, or contact Margaret Morneau at 916-469-3371.

New webinars series

Aging Services of California has partnered with Salient Networks to offer a series of webinars on innovative ways to address an organizations' business challenges. Discover what is new in technology. The first webinar, "Disaster Notification ­ It's Not Just for Disasters," is scheduled for August 13, 2009, 10 a.m. ­ 11 a.m. This webinar has been approved for one hour NHAP/P, RCFE, CASP, BRN continuing education units. Upcoming topics include: · Phone & Internet Revenue ­ It's Not Just for the Phone and Cable Companies. September 16, 10 a.m. ­ 11 a.m. August 2009

Aging Services of California has partnered with several organizations to provide our members with timely, accessible and affordable education opportunities. Maun-Lemke and the Professional Development Network (PDN), comprised of education directors from the state affiliates of AAHSA, have created a new way to learn via the Internet. Anticipate CEU and non-CEU courses on vital topics for aging services providers presented by nationally recognized speakers. The IHN University offers an easy to use website; high level information and courses for all staff and management needs; proven course authors and healthcare experts. Check out the website at www. for related details. Texas Association of Homes and Services for the Aging offers training on Fair Housing. Last year marked the 40th anniversary of the passage of the federal Fair Housing Act. Much progress has been made eradicating discrimination in housing. This presentation will review the requirements of the Fair Housing Act as it applies in the long-term care context and discuss the implication of the Fair Housing Act on marketing, admissions and transfers, and specific operational issues, and how they affect Fair Housing in aging services. Training is available anytime from anywhere. To register, visit and click on Fair Housing Seminar. For more details, call 512-467-2242.

2009 West Coast Conference on Aging

Aging Services of California is a partner organization with the American Society on Aging for the upcoming 2009 West Coast Conference on Aging in Oakland on September 8-11, 2009. As a member of Aging Services, attendees receive a special member rate. For more information go to www.



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ag-ing v. 1 To grow and mature, 2 to experience life (as in "We all are aging; some with more experience than others.")

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