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FAIR USE NOTICE FAIR USE NOTICE: This page may contain copyrighted material the use of which has not been specifically authorized by the copyright owner. This website distributes this material without profit to those who have expressed a prior interest in receiving the included information for scientific, research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107.

Read more at: http://www.etupdates.com/fair-use-notice/#.UpzWQRL3l5M | ET. Updates
FAIR USE NOTICE FAIR USE NOTICE: This page may contain copyrighted material the use of which has not been specifically authorized by the copyright owner. This website distributes this material without profit to those who have expressed a prior interest in receiving the included information for scientific, research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107.

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Sunday, October 26, 2014

HUD-Sponsored Senior Housing Programs


Senior Living




HUD-Sponsored Senior Housing Programs

Chris Hawkins Written by Chris Hawkins
SeniorLiving.Org Expert on Senior Care & Assisted Living 
  


The first wave of baby boomers—those born between 1946 and 1964—made it to age 65 in 2011. Now a person turns 65 every 10 seconds. By 2030, the number of persons 65 and older will reach 71.5 million.

Many in this enormous human wave will need affordable living options once they stop working and there are several HUD programs to help seniors. Because let’s be honest: many folks are not as prepared for retirement as they would like to be.

A survey by the Insured Retirement Institute found that “70 percent of middle-income Boomers are not confident in having enough money to live comfortably in retirement.” In an Associated Press poll, among families with incomes below $50,000, only 35% said they felt financially ready for retirement; 66% of those in higher income households felt ready. With the recent economic collapse, many older adults find themselves in an unexpected position entirely.

A recent AARP Public Policy Institute Study found that:
Another daunting issue facing retirees is the cost of senior living options. Senior living is a general term that includes all kinds of senior-centered housing: independent living, assisted living, nursing homes, home care, and others.
Here’s a sample of what you can expect in senior living costs. The median U.S. cost for a private room in a nursing home is $81,030 a year; in 2007, the median annual cost was $65,700. The average yearly cost in an assisted living facility is $39,600.

Now let’s look into the future.

If you are currently living in Virginia, for example, and needed assisted living care the median amount you would pay is $41,775 a year, according to a Genworth Financial long-term care survey. In 10 years, you would pay $68,047. A private room in a Virginia nursing home would now cost $82,125 a year; in 10 years, the price tag goes up to $133,773.

Even if you never need senior living care, you may find yourself in a position where you have to make a lifestyle change. Asking yourself the important questions is a great place to start.

Retirement Living Considerations 

It may be years after you retiree that you need to make a major living change. But it’s better to plan now and initiate changes on your own rather than being forced by circumstances in the future.

Here are some questions to think about as you prepare for your retirement:
  • Where do I want to live when retired?
  • Where can I afford to live after I stop working?
  • Should I downsize and move into an apartment or condominium?
  • Do I want to live in a senior community with people my age?
  • Should I rent?
  • Do I still feel safe in my current neighborhood?
  • Do I want to be closer to family?
  • Does my health (or my spouse’s) require special living arrangements such as assisted living or a nursing home?
  • Could I afford the cost of assisted care?
  • Can friends and family provide assistance with daily living if I need it?
If your current or future financial circumstances call for a drastic reduction in cost of living, HUD may have a program that can help.

Introduction to HUD Programs

The U.S. Department of Housing and Urban Development (HUD) creates affordable housing for citizens across the country by funding programs for rent assistance, home ownership, and assistive services for seniors and the disabled.
HUD helps more than 900,000 seniors with affordable housing through its programs. There are three types of affordable rent programs: public housing, multifamily subsidized housing, and voucher housing programs.
  • Public Housing is owned and run by local Public Housing Agencies (PHAs).
  • Multifamily Subsidized Housing is privately owned housing that is subsidized by HUD and provides tenants with affordable housing.
  • Housing Vouchers provide rental assistance to individuals and families for housing in the private market.
*Several important things to keep in mind with HUD programs:
  1. The waiting lists are often long (from two to five years), especially in metro areas.
  2. For those in need of assisted care, HUD options are limited. HUD programs are designed primarily for independent seniors.
  3. Because one Public Housing Agency (PHA) doesn’t have the housing you’re looking for, doesn’t mean another one won’t.
We’ll look at HUD housing options, especially as they pertain to seniors. And we’ll look at how to qualify, and how to search for HUD-sponsored housing in your area.

Housing Vouchers

Housing Choice Voucher Program (formerly Section 8)
The Housing Choice Voucher Program (HCVP) provides rent vouchers for housing in the private market to low income individuals, families, the elderly and the disabled. It is the largest assisted housing program administered by HUD.
These vouchers are linked to specific properties run by local Public Housing Agencies (PHAs). There are two kinds of vouchers: tenant-based and project-based. Tenant based vouchers (TBVs) move with the renter. Project based vouchers (PBVs) are assigned to particular units and buildings and are not transferable.

Who is Eligible? 

There is no age requirement. Families or individuals who meet the extremely low-income requirements (30% of the area’s median), and very low income (50% of area median) based on total gross income. In some cases, those with low income (80% of area median) are eligible.

Income such as pensions, retirement accounts, IRAs, insurance annuities, and assets such as real estate, cars, etc. ARE counted when assessing eligibility.

Housing

Depending on your location, housing options can include single-family homes, townhouses and apartments. Individuals can pick anywhere they want to live as long as the owner agrees to rent using the program’s guidelines.

Rent Amounts

Rental amount is calculated by using the greatest of:
  1. 30% of monthly adjusted income
  2. 10% of monthly income
  3. The welfare rent in as-paid states
  4. Or the PHA minimum rent ($25 or up to $50).
PHAs pay the property owner directly and the residents pay the difference to the property owner.

How Do I Apply?

Apply at your local PHA. They will collect information on family income (tax returns, bank statements, Social Security, etc.) assets, and family composition. Medical expenses, health insurance payments, prescriptions and future medical expenses are taken into consideration.

Once you apply, you are placed on a waiting list. Because of the demand, waiting lists are often several years long. Ask your application to be pre-qualified for income—that way you know ahead of time if you qualify. And ask about local preferences (e.g. you are involuntarily displaced, paying more than 50% rent, etc.).

Find a PHA at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts
Homeownership Vouchers
This HUD program assists first time homebuyers who need help meeting their monthly mortgage payment and other expenses. These expenses include mortgage principal and interest, mortgage insurance, real estate taxes, and homeowner’s insurance among others.

Who is Eligible?
  • First-time homeowner
  • No family member has owned or had ownership interest in their residence for at least three years
  • No family member has any ownership interest in any residential property
Employment not required for elderly or disabled families or individuals but must meet certain income requirements
  • Must complete the PHA’s homeownership counseling
  • Any other PHA requirements
Finding Housing 

Assistance by the PHA is not given in finding a home. The applicant must find an approved financing source to purchase the home. The home must pass an inspection by the PHA and an independent inspector before the family can purchase.

Payment Amount 

The monthly tenant payment is generally 30% of the family's adjusted monthly income. The PHA will make the voucher payment to either the lender or the family. There is no time limit to receive assistance under this program for the elderly and disabled.

How Do I Apply?

Contact your local PHA for assistance. Not all PHAs offer this program.
You can find a list of participating PHAs at:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/programs/hcv/homeownership
Programs for Current Homeowners who Need Help
If you own your home and need help with your mortgage, HUD and the Department of Treasury have a handful of programs to help. These include:
  • Lowering your payments
  • Lowering your interest rate
  • Help paying a second mortgage
  • Help with fallen home value
  • Leaving your home and avoiding foreclosure
  • Mortgage modification for those in the military
See MakingHomeaffordable.gov for more details.

Multifamily Subsidized Housing Programs

Section 202 Supportive Housing for the Elderly
The rent-assisted housing in this program is designed specifically for seniors and the disabled to live as independently as possible but who may need some assistance with activities of daily living (ADLs) such as dressing and bathing. Common features of these communities include housekeeping, transportation, referral services, and counseling.

The types of services and amenities will vary by housing community.
Established by HUD in 1959, the Section 202 program is the only program within HUD to provide housing exclusively to seniors. HUD provides loans to private, nonprofit organizations to finance the construction of supportive housing for very low-income seniors and provides rent subsidies.

Who is Eligible? 

Those 62 and older with very low household income (50% of area median). The average resident age is 79. The average yearly income is $10,018.

Type of Housing

Typically, one-bedroom apartments with kitchen and bath, plus special features such as grab bars, ramps, nonskid flooring, etc. Other features include housekeeping, transportation to health care, home-delivered meals.
Rent Amount

Rental amount is calculated by using the greatest of:
  1. 30% of monthly adjusted income
  2. 10% of monthly income
  3. The welfare rent in as-paid states
  4. Or the PHA minimum rent ($25 or up to $50).
How Do I Apply? 

Contact the individual housing community you are interested in. You can find housing by state here: http://www.hud.gov/apps/section8/
Wait lists are usually at least a year. Preferences for admission include those currently paying 50% of their income in rent; the involuntarily displaced; and those living in substandard housing.

Congregate Housing Services Program (CHSP)

This program, started in 1978, provides funds to Section 202 housing communities to “help frail and persons with disabilities avoid premature or unnecessary institutionalization.” This limited but valuable program provides funding to 51 public housing agencies and private assisted housing owners.
These communities provide residents at least one hot meal per day in a group setting, 7 days per week. Other non-medical services provided include housekeeping, personal assistance, transportation and social services.
Contact your local PHA to see if the program is available at area elderly housing locations.
Multifamily Rental Housing for Moderate-Income Families (Section 221 (d) (3))
This program funds “multifamily housing for moderate-income households, including projects designated for the elderly.” Some of the housing is designed specifically for the elderly and handicapped.

Who is eligible?

Anyone can occupy a home that is insured under this program and are “subject to normal tenant selection.” There are no income limits.

Type of Housing

These are multifamily housing units: apartments, condominiums, duplexes, etc.

Rent 

Rent is based on a flat approved HUD amount, not on a tenant’s percentage of income.

How Do I Apply?

Contact your local PHA. For a list by state, go to
http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/programs/hcv/homeownership
Supportive Housing for Persons with Disabilities Program (Section 811)
This purpose of this program is to enable those with disabilities to live as independently as possible in a housing environment that provides supportive services. Services may include personal assistance; meals; housekeeping; counseling; training in independent living skills; recreation and transportation.
HUD awards funds to private non-profit organizations to be used to finance the construction or rehabilitation of supportive housing for persons with disabilities. There are two types of funding programs: 1) projects funded by capital advances and 2) those funded by Project Rental Assistance.

Who is Eligible?

Those who are 18 and older who are physically, mentally, emotionally and/or developmentally disabled. Households must be very low-income (50% of median income) with at least one adult member with a disability.

The Project Rental Assistance Program residents must be extremely low-income (30% of median income) with at least one adult member with a disability
Median household income for residents is $9,204.

Housing

Group homes of eight or fewer units are single family structures that combine multiple bedrooms with a kitchen and shared living area. There is at least one bathroom for every four residents.

Condominium or cooperative units are independent living facilities that can be cooperatively owned by the residents.

Independent living complexes consist of 16 or fewer units where each dwelling contains a kitchen and bathroom. This housing may also contain congregate dining, laundry, and community areas.

Rent Amount

Rent is determined at 30% of adjusted monthly income.

How Do I Apply?

You can find out more on this program and the available properties by contacting your local HUD office. For a listing of regional HUD offices, visit http://portal.hud.gov/hudportal/HUD?src=/localoffices

Public Housing

Public housing is rental housing for low-income families, the elderly and those with disabilities. HUD administers funding to local PHAs that manage the housing. Over 1 million families live in public housing.

Who is Eligible?

Low-income families (80% of median) and individuals including the elderly and those with a disability. Income limits will vary based on area. Your local PHA can provide those limits.

Once you are accepted in public housing, you must live in the community where you are accepted.

Type of Housing

Public housing can include everything from single-family homes, to duplexes to high-rise apartments.

Rent Amount

Rent is referred to as Total Tenant Payment (TTP) and calculated using the greatest of:
  1. 30% of monthly adjusted income
  2. 10% of monthly income
  3. The welfare rent in as-paid states
  4. Or the PHA minimum rent ($25 or up to $50)
You may stay in the property as long as you comply with the lease.


How Do I Apply? 

Contact your local public housing agency to apply. You will need to provide proof of income such as tax returns, bank statements, Social Security award letters, etc. Preferences are usually given to the elderly and disabled.

Key Definitions, Eligibility And Additional Resources

Activities of Daily Living (ADLs): Activities necessary for one to maintain independence. These typically include eating, dressing, bathing, toileting, and transferring.

Fair Market Rents (FMRs) are gross rent (rent plus utilities) estimates used to determine payment amounts for the Housing Choice Voucher program. These rent estimates are used as a guide for determining initial rental payments based on unit size.

Public Housing Agencies (PHAs): Over 2,600 state, regional, and local
HUD-funded agencies that serve the housing needs of its low-income and very low-income residents.

Adjusted Income: Annual income - deductions = adjusted income. Deductions include dependents; status as elderly or disable family; unreimbursed expenses for childcare, medical expenses (elderly and disabled only); and disability assistance.
  • Extremely Low Income: income does not exceed 30% of an area’s median family income.
  • Very Low-Income: their incomes do not exceed 50% of an area’s median family income.
  • Low Income: their incomes do not exceed 80% of an area’s median family income.
  • Moderate Income: incomes that are no more than 115% of an area’s median family income.
Note: Income limits are adjusted for family size and for areas with unusually high or low family income housing-cost-to-income relationships.

Determining Income and Eligibility

When applying for any of HUD’s housing programs, you will be asked to provide proof of income and assets to determine eligibility. Qualifying income and assets are combined when determining income eligibility.

Income and assets include all amounts that are derived in a 12-month period to which any member of the family has access to.

Income Sources

HUD counts the following main sources when considering income for its programs:
  • Full amount of income (before deductions) from salaries, wages, tips
  • Business net income
  • Interest, dividends, and other net income of any kind from real or personal property
  • The full amount of periodic amounts received from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits
  • Unemployment, worker’s comp, and disability
  • Alimony and child support
  • Armed forces income
  • Welfare assistance
For a detailed listing of income sources, go to http://www.gpo.gov/fdsys/pkg/CFR-2012-title24-vol1/xml/CFR-2012-title24-vol1-sec5-609.xml

Assets and Income from Assets*
  • Stocks, bonds, Treasury bills, certificates of deposit,
  • Individual retirement and Keogh accounts
  • Retirement and pension funds
  • Cash held in savings and checking accounts, safe deposit boxes, homes, etc.
  • Cash value of whole life insurance policies available to the individual before death
  • Equity in rental property
  • Personal property held as an investment
*If the total value of assets is less than $5,000, then that number is used in the calculation. If the total value of assets is worth $5,000 or more, the amount of the assets is determined by using the greater of:
  1. The actual income from the assets
  2. A percentage of the value of net family assets based on the passbook savings rate. Each HUD field office determines their own passbook savings rate based on average savings account rates. Most PHAs use 2%.
Example 1: You have assets totaling $20,000 and annual income totaling $40,000.
$20,000 x 2% = $400
$400 assets + $40,000 annual income = $40,400 total income

Example 2: Upon retirement, you receive a lump-sum payment of $10,000 from your pension plan. You then receive periodic pension payments of $500 a month. The $10,000 is treated as an asset as are the monthly $500 pension payments.
$10,000 + $500 x 12 (months) = $16,000

Income Deductions
  • An elderly household is entitled to an automatic $400 household deduction.
  • Medical deductions including services of a physician, health care professional, hospital or health care facility; medical insurance premiums; prescription and non-prescription medicines; dental expenses; eye glasses and examinations; periodic payments of medical bills; et al.
  • Disability assistance expenses
  • Dependent deductions
  • Child care deductions
HUD Income Limits: An Example

HUD has established Median Family Income (MFI) limits for metropolitan and non-metropolitan areas across the U.S. These MFIs are used to calculate eligibility in the various HUD programs.

Here’s an example of an income limit calculation for the Washington DC Metro Area that includes nearby counties in Maryland and Virginia.

Area’s Median Income= $107,500
2012 Income Limit Category
1 Person
2 Person
3 Person
4 Person
Very Low (50%)
$37,650
$43,000
$48,400
$53,750
Extremely Low (30%)
$22,600
$25,800
$29,050
$32,250
Low (80%)
$49,200
$56,200
$63,250
$70,250

You’ll notice that the percentages don’t always equal the income limit amounts. For example, 80% of $107,500 is $86,000, not $70,250.

In their calculations, HUD compares an area’s 4-person family incomes to that of the US median family income. They also look at the Fair Market Rent (FMR) costs for the area.

To find income limits in your area, go to http://www.huduser.org/portal/datasets/il/il2012/select_Geography.odn

Getting Started

To get an idea of the HUD insured and HUD subsidized multifamily properties that serve the elderly and/or persons with disabilities you can go to
http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/mfh/hto/inventorysurvey

This list does not provide waiting list info, availability, eligibility and tenant selection. But it will provide a listing of properties by state and by HUD program (Section 202, Section 811, etc.) that finances/subsidizes each property. This will give you an idea of the type of services offered and potential eligibility.
You can also go to HUD’s Rental Assistance page for links to the various programs:

http://portal.hud.gov/hudportal/HUD?src=/topics/rental_assistance

HUD Counseling

If you’re not sure where to start in your search, try calling a HUD-sponsored housing counseling agency in your area. These counselors provide advice on buying a home, renting, credit issues, foreclosures and other housing related issues.

For a list of HUD approved counselors by state, go to http://www.hud.gov/offices/hsg/sfh/hcc/hcs.cfm

Wednesday, October 15, 2014

The Geezers: We won't grow old gracefully



 




The Geezers: We won't grow old gracefully

 

TED JEORY meets a group of East End pensioners who are refusing to fade away. With a positive outlook, these redoubtable Geezers are now reaching out to today’s youth.



The Geezers inspirational work with local schools and universities has just won a string of awards  

The Geezers' inspirational work with local schools and universities has just won a string of awards []
 
In London’s East End a group  of retired butchers, truckers,  builders, undertakers and boxers  are redefining what it is to be men growing old. They have seized life  by the horns and confronted the spectre of loneliness head on.
Meet The Geezers, a club of can-do pensioners whose inspirational work with local schools and universities has just won a string of awards and sparked curiosity about their success nationwide.

Their aim is that sometime, somewhere, an energetic Geezers Club will be opening near you.

When David Cameron set out his idea of Britain’s Big Society last year his words were largely met with a Big Shrug: few knew what he really meant. If the PM is still trying to illustrate the vision he would do well to look the Geezers’ way.
The club was set up five years ago after research from Age Concern in the London borough of Tower Hamlets showed that few men were turning up to their day centres. While women were being catered for with classes in dressmaking, line dancing and how to be a grandmother none of the activities interested men.

Yes, there were worthy talks about men’s health and eating well but they didn’t capture the imagination of retirees. Instead, many widowers were hanging around in pubs and betting shops or, even sadder, some were seen simply leaning against roadside railings watching the traffic go by.

So a few old friends took matters into their own hands and decided to recapture the things that made them laugh.

They formed their own club, asked for £1 a week subscriptions and sought public funding. They play indoor bowls once a week (an activity so popular that many cancel their hospital appointments rather than miss out) and have regular outings and social gatherings.

However, those are the bread-and-butter ingredients. What makes The Geezers extra-special is their other work. They have won £20,000 in awards and grants while their industry and creative energy has attracted the attention of artists and academics.

Their latest accolade was a cheque for £5,000, handed to them last year by Attorney General Dominic Grieve for a project they undertook with the local Bow Boys comprehensive school. The prize was from the Awards for Bridging Cultures organisation for a touching short film called Bow: Now And Then, which chronicles the reflections of the two different generations growing up in the East End.

Nowhere else in Britain has there been such dramatic change in terms of demographics and urban development. Decimated by Hitler’s Luftwaffe, what was once the engine room of London’s river-borne trade and a centre of Cockney life is now a skyline of gleaming skyscrapers and a defining picture of multiculturalism.

A combination of City expansion from the west, Canary Wharf growth from the south and a wave of mass immigration from Bangladesh has contributed heavily to what social researchers have termed the “white flight” of traditional inhabitants to the suburbs of Essex. In short, older, whiter generations feel alienated in what they see as their own manor. The youngsters, meanwhile, look towards their elders as if they are aliens.

The Geezers’ film was an attempt to address that. They teamed up with Andy Porter from media charity Hi8tus and produced a montage of talking heads and sights and sounds from today and yesteryear.

At just over 15 minutes, the film is a collection of themes about growing up. Each scene juxtaposes tales from life then with teenage thoughts from today.
While Geezers talk about playing in bomb craters, kicking footballs made of paper in traffic-free side streets and courting their sweethearts in Epping Forest, today’s youth chat about computer games, hang around housing estates and chat up girls by text message.

With so much concern about violent gang culture in modern Britain and especially inner-city London, the discussion about “territory” was perhaps the most illuminating. Today’s postcode gangs are a modern version of a problem that has always existed.

Johan Campo Marin, 16, recounts in the film how he and his cousin were asked “what end?” or what postcode, they were from as they walked through the Elephant & Castle district in South East London. When they replied Tower Hamlets, they were chased by a gang.

To the older generation that was nothing new. Even venturing on to the other side of a railway bridge in their day risked trouble. However, 81-year-old Ted Lewis, a former Billingsgate fish market porter and amateur featherweight boxer, said there was an honour to their day’s toughness.

“We would have gang fights,” he says. “A neighbourhood would bring their champion and we would have our champion and the two would fight each other. If you kicked someone you were a coward. You had to stand up and fight properly.”

Ted, a former Liberal Democrat councillor, is one of the stars of the film and when The Geezers met the boys again at their school last month, he was still showing off his strength and boxing skills.

“It’s been wonderful getting involved with them,” he said, reflecting on the film. “I found that we can talk to these young children and they can also talk to us.” Johan agrees: “We thought they would be really boring but after talking to them we just thought they were really just the same as us.”

Jim Morris, the head of the pupils’ year group at school, adds: “The great thing is that it broke down the barriers and stereotypes that both groups came with. They couldn’t understand the world in which The Geezers used to live as children when there was so much more space to play and where they were free to roam.”

So what next for The Geezers? They have aready helped form a women’s group called The Bow Belles and five years after their first meeting, the local phenomenon they have created is, they hope, set to spread across Britain. Chief Geezer Ray Gipson, 70, an ex-lorry driver, football referee and another former Lib Dem councillor, says they have already worked with the University of East London on renewable energy projects and they even made a wind turbine that lit a sign over Tower Hamlets boasting “Geezer Power”.

Ray wants more men from around Britain to follow their example. “People just seem to let men grow old and senile,” he says. “We just didn’t want to have a talking club. We wanted to be talking about doing something and then actually doing something.”

Geezer Power is on its way.

Saturday, May 3, 2014

A Preview of the 2015 Medicare Part D Standard Drug Plan Coverage

Q1Medicare.com


Click to Enter Your Drugs and Compare Medicare Part D Plans



Medicare Part D Prescription Drug Plan Newsletter

Q1Medicare.com

Q1Group LLC

Spring 2014




A Preview of the 2015 Medicare Part D Standard Drug Plan Coverage


Question:  Is there information already available on the 2015 Medicare Part D plans?

Yes.  The Centers for Medicare and Medicaid Services ( CMS ) has recently released their standard limits for basic Medicare Part D prescription drug plan coverage.  A chart comparing the CMS Medicare Part D defined standard benefit parameters from 2011 through 2015 is available at Q1Medicare.com/2015, and here are a few highlights of the changes to basic 2015 Medicare Part D plan coverage:

  • The Donut Hole discount will increase for generic drugs:  Next year, if you reach the Donut Hole phase of your Medicare Part D plan coverage, the 2015 generic drug discount will increase from 28% to 35% and your 35% discounted drug cost will count toward meeting your 2015 total out-of-pocket maximum or Donut Hole exit point.  So if your generic medication has a retail cost of $100, you will pay $65, and the $65 will count toward your out-of-pocket spending limit.

  • The Donut Hole discount will increase for brand-name drugs:  The 2015 brand-name drug discount will increase from 52.5% to 55% and you will receive credit for 95% of the retail drug cost toward meeting your 2015 total out-of-pocket maximum or Donut Hole exit point (the 45% you spend plus the 50% drug manufacturer discount).  So if you have a brand-name medication with a retail cost of $100, you will pay $45 for the medication, but get credit for $95 toward meeting your out-of-pocket spending limit.

  • The standard initial deductible will increase: During the initial deductible, you are responsible for paying 100% of your drug costs before your Medicare Part D prescription drug plan coverage begins.  The 2015 initial deductible will increase $10 to $320 from the current 2014 value of $310 (these are the same changes we saw from 2011 to 2012).  This means that if you have an initial deductible in 2015, you will pay slightly more before your plan coverage begins.  However, some 2014 Medicare Part D plans currently exclude generic drugs from their deductible and we expect this practice to continue in 2015.  Please note that about half of the Medicare Part D plans offered in past few years have had an initial deductible.  Click here to see an overview of the 2014 Medicare prescription drug plan landscape.

  • The initial coverage limit will increase: This is the negotiated retail dollar value of your prescription drug purchases used to determine when you enter into the 2015 Donut Hole or Coverage Gap phase of your Medicare Part D plan.  Medicare beneficiaries will enter the 2015 Donut Hole or Coverage Gap when the total negotiated retail cost of their prescription drug purchases reaches the initial coverage limit of $2,960, a $110 increase over the 2014 initial coverage limit of $2,850.  This means you will be able to buy slightly more medications before reaching the 2015 Donut Hole (assuming the retail cost of your medications does not change next year).

You can see how the retail value of your medications is changing over time by viewing our retail drug pricing history found at the bottom of the cost-sharing information for any of your covered Medicare Part D plan drugs – you can click here for an example of Atorvastatin 10mg found on the AARP MedicareRx Saver plan formulary in Florida).

  • Total Out-of-Pocket Costs or TrOOP will increase:  TrOOP is the actual dollar figure you must spend to get out of the Donut Hole or Coverage Gap, excluding monthly premiums.  The 2015 TrOOP threshold will increase by $150 to $4,700 from the current 2014 value of $4,550 (again, the same as the change between 2011 and 2012).  As noted above, the brand-name medication purchases in the Donut Hole are discounted by 55%, but you will receive credit of 95% of the retail drug price toward meeting the 2015 TrOOP threshold.

  • Our 2015 Donut Hole calculator shows how these changes will affect your 2015 drug spending budget.  To help you visualize how these 2015 plan changes may impact your prescription drug spending next year, we have launched our 2015 Q1Medicare.com PDP-Planner or Donut Hole calculator found at PDP-Planner.com/2015.  Our PDP-Planner allows you to enter your estimated retail prescription drug costs (based on your current spending) and preview what you can expect to pay throughout the different phases of your 2015 Medicare Part D plan coverage.  To get you started, you can click hereto see an example of the 2015 Medicare prescription drug plan phases for someone with $800 per month retail medication expense.  At the bottom of the chart, we provide different scenarios for generic and/or brand-name drug purchases.


Question:  Will all 2015 Medicare Part D prescription drug plans follow these new plan limits?

No.  The Medicare Part D defined standard benefit parameters are released each year by Medicare and set minimum limits for next year’s standard Medicare Part D prescription drug plan coverage.  However, Medicare Part D providers are allowed to deviate from the defined standard benefits when designing their 2015 plans and, with Medicare’s approval, offer Medicare Part D prescription drug plans with more enhanced features such as a $0 initial deductible or coverage in the Donut Hole.


Question:  When can we see the actual details of the 2015 Medicare Part D and Medicare Advantage plans?

October 1st.  The 2015 annual Open Enrollment Period will begin on October 15th and continues through December 7th.  However, the marketing period for 2015 Medicare plans will begin on October 1st and actual Medicare Part D and Medicare Advantage plan details will become available at this time or a little earlier.  If you would like us to send you a notification when the 2015 Medicare Part D plan information becomes available, please click here to sign-up for our free email 2015 Reminder Service.  We will not share your email information with anyone.


Question:  Will Medicare plans that have a low quality star rating be discontinued in 2015?

Medicare Part D or Medicare Advantage plans that earned a quality star rating of lower than 3-stars for three years in a row will be terminated at the end of 2014.  We will learn which plans will be discontinued in late-September.


Do you have other questions about this 2015 information?  Click here and to let us know.


Thursday, January 23, 2014

Seniors Paying $7,125 a Month to be Neglected? What Happened When Wall Street Got Involved in Assisted Living



 
 

The horrors of some assisted living facilities. 

 
 
 

 

The following story is original to ProPublica. This is part 1 and part 2 of a series on assisted living facilities. 

Joan Boice needed help. Lots of it. Her physician had tallied the damage: Alzheimer’s disease, high blood pressure, osteoporosis, pain from a compression fracture of the spine. For Joan, an 81-year-old former schoolteacher, simply getting from her couch to the bathroom required the aid of a walker or wheelchair.

The Alzheimer’s, of course, was the worst. The disease had gradually left Joan unable to dress, eat or bathe without assistance. It had destroyed much of the complex cerebral circuitry necessary for forming words. It was stealing her voice.

Joan’s family was forced to do the kind of hard reckoning that so many American families must do these days. It was clear that Joan could no longer live at home. Her husband, Myron, simply didn’t have the stamina to provide the constant care and supervision she needed. And moving in with any of their three children wasn’t an option.

These were the circumstances that eventually led the Boice family to Emeritus at Emerald Hills, a sprawling, three-story assisted living facility off Highway 49 in Auburn, Calif. The handsome 110-bed complex was painted in shades of deep green and cream, reflecting its location on the western fringe of the craggy, coniferous Sierra Nevada mountain range. It was owned by the Emeritus Corp., a Seattle-based chain that was on its way to becoming the nation’s largest assisted living company, with some 500 facilities stretching across 45 states.
Emeritus at Emerald Hills promised state-of-the art care for Joan’s advancing dementia. Specially trained members of the staff would create an individual plan for Joan based on her life history. They would monitor her health, engage her in an array of physically and mentally stimulating activities, and pass out her 11 prescription medications, which included morphine (for pain) and the anti-psychotic drug Seroquel (given in hopes of curbing some of the symptoms of her Alzheimer’s). She would live in the “memory care” unit, a space designed specifically to keep people with Alzheimer’s and other forms of dementia safe.
At Emerald Hills, the setting was more like an apartment complex than a traditional nursing home. It didn’t feel cold or clinical or sterile. Myron could move in as well, renting his own apartment on the other side of the building; after more than 50 years of marriage, the couple could remain together.

Sure, the place was expensive — the couple would be paying $7,125 per month — but it seemed ideal.

During a tour, a salesperson gave Myron and his two sons, Eric and Mark, a brochure. “Just because she’s confused at times,” the brochure reassured them, “doesn’t mean she has to lose her independence.”

Here are a few things the brochure didn’t mention:

Just months earlier, Emeritus supervisors had audited the facility’s process for handling medications. It had been found wanting in almost every important regard. And, in truth, those “specially trained” staffers hadn’t actually been trained to care for people with Alzheimer’s and other forms of dementia, a violation of California law.

The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long. During the three years prior to Joan’s arrival, Emerald Hills had cycled through three nurses and was now employing its fourth. At least one of those nurses was alarmed by what she saw, telling top Emeritus executives — in writing — that Emerald Hills suffered from “a huge shortage of staff” and was mired in“total dysfunction.”
During some stretches, the facility went months without a full-time nurse on the payroll.

The paucity of workers led to neglect, according to a nurse who oversaw the facility before resigning in disgust. Calls for help went unanswered. Residents suffering from incontinence were left soaking in their own urine. One woman, addled by dementia, was allowed to urinate in the same spot in the hallway of the memory care wing over and over and over.

The brochure also made no mention of the company’s problems at its other facilities. State inspectors for years had cited Emeritus facilities across California, faulting them for failing to employ enough staff members or adequately train them, as well as for other basic shortcomings.
Emeritus officials have described any shortcomings as isolated, and insist that any problems that arise are promptly addressed. They cite the company’s growing popularity as evidence of consumer satisfaction. They say that 90 percent of people who take up residence in assisted living facilities across the country report being pleased with the experience.

Certainly, the Boice family, unaware of the true troubles at Emerald Hills, was set to be reassured.

“We were all impressed,” recalled Eric Boice, Joan’s son. “The first impression we had was very positive.”

And so on Sept. 12, 2008, Joan Boice moved into Room 101 at Emerald Hills. She would be sharing the room with another elderly woman. After a succession of tough years, it was a day of great optimism.
Measuring the dimensions of his mother’s new apartment, Eric Boice sought to recreate the feel of her bedroom back home. He arranged the furniture just as it had been. He hung her favorite pictures in the same spots on the wall. On her dresser, he set out her mirror and jewelry box and hairbrush.
Joan, 5-foot-2 and shrinking, had short snow-and-steel hair and wintry gray-blue eyes. Eric looked into those eyes that day at Emerald Hills. He thinks he might have seen a flicker of fear. Or maybe it was just confusion, his mom still uncertain where, exactly, she was.
A Reform Movement Winds Up on Wall Street
The Emeritus Corp., the assisted living corporation now entrusted with Joan’s life, sat atop an exploding industry.

Two decades earlier, Keren Brown Wilson had opened the nation’s first licensed assisted living facility in Canby, Ore., a small town outside of Portland. Wilson was inspired by tragedy: A massive stroke had paralyzed her mother at the age of 55, forcing her into a nursing home, where she was miserable, spending the bulk of her days confined to a hospital bed.

Wilson aimed to create an alternative to nursing homes. She envisioned comfortable, apartment building-style facilities that would allow sick and fragile seniors to maintain as much personal autonomy as possible.

“I wanted a place where people could lock the door,” Wilson explained. “I wanted a place where they could bring their belongings. I wanted a place where they could go to bed when they wanted to. I wanted a place where they could eat what they wanted.”


These “assisted living” facilities would offer housing, meals and care to people who could no longer live on their own but didn’t need intensive, around-the-clock medical attention. The people living in these places would be called “residents” — not patients.


It took Wilson nine years to persuade Oregon legislators to rewrite the state’s laws, a crucial step toward establishing this new type of facility. After that, states across the country began adopting the “Oregon model.”

But what began as a reform movement quickly morphed into a lucrative industry. One of the early entrants was Emeritus, which got into the assisted living business in 1993, opening a single facility in Renton, Wash. The company’s leader, Daniel Baty, had his eyes on something much grander: He was, he declared, aiming to create a nationwide chain of assisted living facilities.
Two years later, Baty took the corporation public, selling shares of Emeritus on the American Stock Exchange, and piling up the cash necessary to vastly enlarge the company’s footprint. Many of Emeritus’s competitors followed the same path.

The company’s rapid growth was, at least in part, a reflection of two significant developments. Americans were living longer, with the number of those in the 65-plus age bracket ballooning further every year. And this growing population of older Americans was willing to spend serious money, often willing to drain their bank accounts completely to preserve some semblance of independence and dignity — in short, something of their former lives.

As the assisted living business flourished, the federal government, which oversees nursing homes, left the regulation of the new industry to the states, which were often unprepared for this torrent of expansion and development. Many states didn’t develop comprehensive regulations for assisted living, choosing instead to simply tweak existing laws governing boarding homes.

In this suddenly booming, but haphazardly regulated industry, no company expanded more aggressively than Emeritus. By 2006, it was operating more than 200 facilities in 35 states. The corporation’s strategy included buying up smaller chains, many of them distressed and financially troubled, with plans to turn them around.

Wall Street liked the model. Market analysts touted the virtues of the company and its stock price floated skyward. One of the corporation’s appeals was that its revenues flowed largely from private bank accounts; unlike hospitals or nursing homes, Emeritus wasn’t reliant on payments from the government insurance programs Medicare or Medicaid, whose reimbursement rates can be capped. As the company noted in its 2006 annual report, nearly 90 percent of its revenues came from “private pay residents.”

In filings with the Securities and Exchange Commission and in conference calls with investors, Emeritus highlighted many things: occupancy rates; increasing revenue; a constant stream of complex real estate deals and acquisitions; the favorable demographic trends of an aging America.

“The target market for our services is generally persons 75 years and older who represent the fastest growing segments of the U.S. population,” Emeritus stated in a 2007 report filed with the SEC.

Today, the assisted living industry rivals the scale of the nursing home business, housing nearly three-quarters of a million people in more than 31,000 assisted living facilities, according to the U.S. Department of Health and Human Services.

Keren Brown Wilson, the early and earnest pioneer of assisted living, is happy that ailing seniors across the country now have the chance to spend their final years in assisted living facilities, rather than nursing homes. But in her view, the rise of assisted living corporations — with their pursuit of investment capital and their need to please shareholders — swept in “a whole new wave of people” more focused on “deals and mergers and acquisitions” than caring for the elderly.

She speaks from experience. After her modest start, Wilson went on to lead a company called Assisted Living Concepts, and took it onto the stock market. Wilson left the company in 2001, and it has encountered a raft of regulatory and financial problems over the last decade.

“I still have a lot of fervor,” said Wilson, who now runs a nonprofit foundation and teaches at Portland State University. “I believe passionately in what assisted living can do. And I’ve seen what it can do. But for some of the people, it’s just another job, or another business. It’s not a passion.”

“A Phenomenal Deal”



Joan Boice, born Joan Elizabeth Wayne, grew up in Monmouth, Ill. It was a tiny farm belt community, not far from the Iowa border. Her father, a fixture in the local agriculture trade, owned a trio of riverfront grain elevators on the Mississippi and a fleet of barges. As a teenager, she spent her summers trudging through the fields, de-tasseling corn.

In 1952, accompanied by a friend, Joan packed up a car and followed the highway as far west as it would go. Then in her early 20s, she was propelled by little more than the notion that a different life awaited her in California. In a black-and-white snapshot taken shortly after she arrived, Joan is smiling, a luxuriant sweep of dark hair framing her pale face, gray waves curling in the background. It was the first time she’d seen the Pacific.

Joan had been a teacher for two years in Illinois, and she quickly found a job at an elementary school in Hayward, a suburb of San Francisco. In certain regards, her outlook presaged the progressive social movements that were to remake the country during the next two decades. She viewed education as a “great equalizing force” that could help to remake a society far too stratified by class, race and gender.

“She was just free-spirited and confident,” Eric, her son, said.
Joan met Myron Boice through a singles group at a Presbyterian church in Berkeley. On their wedding day, Joan flouted convention by showing up in a blue dress. The Boice children came along fairly quickly: Nancee, then Mark, then Eric.

Myron Boice was a dreamer. A chronic entrepreneur. He sold tools from a van. He made plans to open restaurants. He had one idea after another. Some worked; others didn’t.

Joan’s passion for education never dissipated. Even in her late 60s, she continued to work as a substitute teacher in public schools. After retirement, she began volunteering with a childhood literacy program.

But age eventually tightened its grip, and hints of a mental decline began surfacing around 2005. Eric grew worried when she couldn’t figure out how to turn on her computer twice in the span of a few months. Then she forgot to include a key ingredient while baking a batch of Christmas cookies. The cookies were inedible.

The elderly couple was still living in the San Francisco suburbs, when, in late 2006, a doctor diagnosed Joan with Alzheimer’s. As her mind deteriorated, Myron struggled to meet her needs. The situation was worsened by the fact that none of the children lived nearby. Mark was in Ohio. Nancee was about an hour away in Santa Cruz. And Eric and his wife, Kathleen, were roughly two hours away in the foothills of the Sierra.

“We offered my parents to come and live with us,” Eric recalled. But Myron said no. He and Joan wouldn’t move in with any of the kids. The family patriarch refused to become a burden.

A physician encouraged Joan and Myron to consider assisted living. It made sense. And so Myron sold their home in 2007 and the couple moved into a facility called The Palms, near Sacramento. The move put them approximately 40 minutes away from Eric and Kathleen.

“They were very attentive to every single thing she needed,” Kathleen Boice said of the staff at The Palms. “They actually re-taught her to eat with a fork and a knife.”

By 2008, however, Myron wanted a change. He wanted to be closer to his son and daughter-in-law and grandkids. He wanted different meals, a new environment. Myron began hunting for a new place to live, a search that led to Emeritus at Emerald Hills in Auburn.

Emeritus opened the Emerald Hills complex in 1998. It was, in many ways, a classic Emeritus facility, situated in a middle-class locale that was neither impoverished nor especially affluent. It was a sizable property, capable of housing more than 100 people.

In part because of its appetite for expansion, Emeritus was in the early stages of what proved to be a period of enormous stress. In 2007, the company had made its biggest acquisition to date, buying Summerville Senior Living Inc., a California-based chain with 81 facilities scattered across 13 states.

The purchase — which expanded Emeritus’s size by roughly one-third — helped the company make another major leap, bouncing from the low-profile American Stock Exchange into the big leagues of commerce, the New York Stock Exchange. News of the Summerville deal propelled the company’s stock to a new high. Emeritus was poised to become the nation’s No. 1 assisted living chain.



But the timing for this bold move turned out to be wretched. The real estate market was freezing up, and it would soon collapse, plunging the nation into an epochal recession. For Emeritus, the economic slowdown and then the housing crash posed direct challenges. Its services didn’t come cheap, so many people needed to sell their homes before they could afford to move into the company’s facilities. With the real estate market calcified, Emeritus’s customer pool shrank.
“Our stock price plummeted,” recalled Granger Cobb, Emeritus’s chief executive officer, who joined the company as part of the Summerville deal. The company’s occupancy rates had been trending skywards. Now they went flat.

At Emerald Hills, the economic slowdown that summer was making life tough for Melissa Gratiot, the lead sales agent.

“It was way harder to move residents in,” she remembered.

But there was some good news. She was close to a significant sale, this one to a couple. Gratiot worked the pitch. She talked with the family. She emailed. She gave them a tour of the facility’s memory care unit, called The Emerald City. She told the family she’d received approval from higher ups to offer the family “a phenomenal deal.”

Gratiot closed the sale. On Aug. 29, 2008, Myron and Eric signed the contract, and the family opened its wallet: A $2,500 initial move-in fee; $2,772 for Joan's first two weeks in Room 101; another $1,660 for Myron.
There had been one oversight, though. No one at Emeritus with any medical training had ever even met Joan, much less determined whether Emerald Hills could safely care for her.

Correction (7/29): An earlier version of this story stated that Emeritus at Emerald Hills had failed a company audit of its memory care unit before Joan Boice moved in. It has been corrected to say an audit found flaws in the facility’s medication handling process before Boice moved in. The memory care unit was audited while Boice was living there and failed nearly every important test.

PART 2 -- "They're Not Treating Mom Well"


When the ambulance crew arrived, about 8:20 p.m., Joan Boice was in the TV lounge, face-down on the carpet. Her head had struck the floor with some velocity; bruises were forming on her forehead and both cheeks. It appeared she’d lost her balance and fallen out of a chair.

But no one at the assisted living facility could say precisely how the accident had occurred. No one knew how long Joan had been splayed out on the floor. She had defecated and urinated on herself.

Worried that Joan might have injured her spine, the emergency medical personnel gently rolled her over and placed her on a back board. They pumped oxygen into her nostrils.

It was Sept. 22, 2008 — just 10 days after Joan had first moved into Emerald Hills.

No Emeritus employees accompanied Joan to the hospital. And even though Joan’s husband, Myron, was living in the facility, the Emeritus workers didn’t immediately alert him that Joan had fallen and hurt herself. Joan, confused, injured, and nearly mute, ended up in the local hospital by herself, surrounded by strangers.


California law requires assisted living companies to conduct a “pre-admission appraisal” of prospective residents, to ensure they are appropriate candidates for assisted living.

But Emerald Hills took Joan in without performing an appraisal. It wasn’t for lack of time. The Boices had signed the contract to live at Emerald Hills more than two weeks before Joan moved in.

Joan, then, had taken up residence in the memory care unit at Emerald Hills. The unit — referred to as a “neighborhood” by the company — is a collection of abouta dozen small apartments on either side of a central hallway. At each end of the hallway are heavy doors equipped with alarms, which sound when anyone enters or leaves. The alarm system is meant to prevent residents from simply walking off.

On the day Joan moved into Room 101 in the unit, a company nurse named Margaret “Peggy” Stevenson briefly looked her over. The nurse realized that Joan needed to be monitored closely to keep her from falling — she wrote it down in her cursory assessment — but facility records show she didn’t craft any kind of detailed plan for her care and supervision.

Stevenson, asked years later about Joan, said she could recall nothing about her or her stay at Emerald Hills.

Kathleen had immediate suspicions about Joan’s fall. The family, she said, had warned the facility not to leave Joan sitting in a chair without supervision because she was liable to try to stand up, lose her balance, and topple to the floor. Joan had fallen several times during an earlier stay in an assisted living facility near Sacramento, but the staff had developed a specific plan to address the issue.

Despite the warning, Kathleen said that when she visited Emerald Hills during Joan’s first days there she often found her mother-in-law sitting in a chair alone.
The recent track record at Emerald Hills featured a host of falls similar to Joan’s, and ambulances were often called to take the injured off to the hospital. Falls are a particular hazard for the elderly, and assisted living facilities like Emerald Hills are required to report them to state regulators.

Internal company records documented 112 falls at Emerald Hills in 2008. Some residents fell repeatedly.

Consider the case of one Emerald Hills resident, 83-year-old Dorothy “Dottie” Bullock.

On April 5, 2008, an Emeritus employee discovered Bullock “on the floor in a semi-seated position” in the memory care unit, according to a state report. She “was unable to tell” the worker what had happened to her. The incident was described as a fall in state records. Emerald Hills sent her to the hospital.
On April 7, Bullock, back at Emerald Hills, fell again, according to the handwritten log of her personal attendant, who was hired by Bullock’s husband to give her extra help.

On April 8, Bullock, complaining of pain, was hauled by ambulance back to the hospital. Doctors concluded that she’d fractured her pelvis, but soon returned her to Emerald Hills. She fell again on April 12.

Bullock would fall again months later, for the final time.



Emeritus records show Bullock tumbled in front of her apartment and was found on the carpet with her aluminum walker beneath her. Blood spilled from her nose and a “bump” developed on her forehead, according to the company documents. The impact broke a vertebra in Bullock’s neck and crushed her nasal bones and sinus structures, hospital records show. A CT scan revealed possible fractures of both eye-sockets and the base of the skull.
Dottie Bullock died in the emergency room.

While Emeritus recorded the fatality in its internal logs, the company did not report her death to state regulators, a violation of California law. The state requires assisted living facilities to file reports on all deaths, even those believed to be from natural causes, so that it can look into suspicious or troubling incidents.

Emeritus said it lacked information about Bullock’s death and thus could not say why it had occurred.

Bullock’s personal attendant, Julie Covich, says Bullock was not supervised properly.

“I think there was neglect,” said Covich, who usually visited Emerald Hills once or twice a week to help out Bullock. “I would go in there and never see a caregiver.”

“It was hard to find anyone that was running the place,” she said. “It was crazy.”

“Heads on the Beds”


In early 2008, the year Joan Boice entered Emerald Hills, Emeritus rolled out a new business campaign. The company dubbed it the “No Barriers to Sales” effort.

The concept was straightforward: Move as many people as possible into Emeritus facilities. Wall Street was looking closely at the company’s quarterly occupancy numbers and a few percentage points could propel the stock price upward or send it tumbling down.

With the housing market foundering, Emeritus needed to step up its sales efforts.
In case there was any confusion about just how seriously the company took this new campaign, a company vice president sent a blast email to facility directors across California. In the body of the email, the vice president got right to it:“SALES and your commitment to sales is your highest priority right now.” Facility directors, the message concluded, would be “held responsible for census and occupancy growth.”

Emeritus employees across the country realized they were entering a new era.
“There was a different sense of urgency. The tone was different,” said a former Emeritus manager who ran a facility at the time. “The message from above was put as many people as possible in the beds and make as much money as possible. That’s what they said. Verbatim. Honestly.”

According to Lisa Paglia, a regional executive in California at the time, Budgie Amparo, the company’s top official for quality control, was openly critical when a Northern California facility declined to admit someone who did not have a doctor’s evaluation.

Such evaluations, which are designed to keep out seniors with problems that assisted living facilities aren’t equipped to handle, are required under a California law known as Title 22.

But on a conference call with roughly half a dozen California managers, Paglia said, Amparo declared that the Northern California facility should have admitted the resident.

“Our priority,” Amparo declared, according to Paglia, “is to get the heads on the beds.”

The issue arose again in October 2008 during a training session for approximately 25 facility directors and salespeople held at an Emeritus property in Tracy, Calif. During the seminar, a company vice president reiterated Amparo’s instruction to disregard California law, according to court records and interviews.

The mandate prompted something of a staff revolt.

At least one facility director spoke out at the meeting: His license to operate the facility was at stake, he said.

An employee who worked at the Tracy facility eventually alerted California regulators. The state dispatched an investigator, and state records show that the investigator met with employees who confirmed that a company official had approved the practice of admitting someone without a doctor’s report. The investigator reviewed a random sample of seven resident files, finding that two people had been moved in illegally, documents show.




Amparo, a nurse whose full title is executive vice president of quality and risk management, denies directing employees to violate the regulation. In a written statement, Emeritus said, “Neither Budgie Amparo nor any of our other officers issued a directive to violate Title 22 or any other law. Emeritus does not condone allowing residents to move in without the proper documents.”

Emeritus eventually fired Paglia, and lawyers for the company have since portrayed her as a poor worker who failed to do her job competently. Along with two other former Emeritus employees, Paglia sued the company alleging wrongful termination, and wound up settling on secret terms.

For assisted living chains such as Emeritus, there is a powerful business incentive to boost occupancy rates and to take in sicker residents, who can be charged more.

Emeritus, for its part, rejects any suggestion that a quest for profits has tainted its admission practices. But in interviews, former Emeritus executives described a corporate culture that often emphasized cash flow above all else. The accounts of the executives, who spoke independently but anonymously, were strikingly consistent.

“It was completely focused on numbers and not human lives,” said one executive, who worked for Emeritus for more than three years and oversaw dozens of facilities in Eastern states.

The company’s emphasis on sales and occupancy rates, the executive said, transformed the workforce into “a group of people who were grasping at every single lever they could pull to drive profitability.”

Emeritus operates a sophisticated, data-driven sales machine. There are occupancy goals for each facility, as well as yearly company-wide goals. The company tracks dozens of data points — including every move-in and move-out of residents — in a vast database. It posts a monthly snapshot of each facility’s sales statistics on an internal website, allowing employees to see which strategies are most successful.


Sales specialists are instructed on how to use psychology to persuade potential customers to sign on. One suggestion: Give the customer “a sense of control and choice by offering two possible options.” A 2009 Emeritus sales manual, which runs 181 pages, encourages sales people to generate publicity by hosting seminars on Alzheimer’s or organizing charity efforts in the event of a natural disaster like a “flood or earthquake.”

Emeritus motivates its workforce with a broad range of financial incentives. There are bonuses for hitting monthly occupancy goals. Bonuses for hitting yearly occupancy goals. Bonuses for boosting overall earnings. And the money doesn’t just go to sales people: The company hands out checks to maintenance workers, nurses, facility directors and other workers.

Nurses play a key role in assisted living, providing much of the hands-on care. But nurses at Emeritus facilities are also expected to be deeply involved in increasing revenue by making sales.

During more than a year of reporting, ProPublica and PBS Frontline spoke to 10 facility directors who said nurses were required to participate in weekly conference calls focusing on little but economics. Those accounts are backed by an internal Emeritus document that lays out the agenda for the weekly calls and that shows an overarching concentration on finances.

Doris Marshall was at the forefront of Emeritus’s efforts to have nurses play the dual roles of caregivers and salespeople. After receiving her nursing license in 1984, Marshall had spent many years tending to patients in the emergency department of a Southern California hospital, and she’d later gone on to help run a nursing school.

But Marshall was intrigued by the assisted living business and in March 2008 she signed on to supervise 10 Emeritus properties scattered across Northern California. Amparo, the company’s head nurse, convinced Marshall to take the job, telling her nurses “had a voice” at Emeritus.

Marshall was to oversee the well-being of roughly 800 elderly people. But her job description went well beyond that: She was to help with “marketing” and “attaining financial goals.” Her job, in the end, actually involved very little nursing.

Instead, she said, she was drawn into Emeritus’s evolving strategies aimed at upping its revenues. The company planned to bring in more seniors with Alzheimer’s and dementia because they could be charged more, she said. Her boss gave her a digital tracking tool showing how much more money Emeritus could make by admitting sicker, frailer residents.

By the fall of 2010 Marshall was worn out and disillusioned. She quit.
Emeritus’s extraordinary drive to put heads in beds — perhaps routine in, say, the hotel industry — has distorted the admissions process at some facilities, records and interviews show. Since 2007, state investigators have cited the company’s facilities more than 30 times for housing people who should have been prohibited from dwelling in assisted living facilities.

A 2010 episode at an Emeritus facility in Napa highlighted the perils of improperly admitting people. The facility rented a room to a 57-year-old woman with an eating disorder, depression, bipolar disorder and a history of suicide attempts. The woman, who was distraught over the death of her husband, taped a note to her door saying she wasn’t to be disturbed and committed suicide, overdosing on an amalgam of prescription painkillers.

The state’s investigation into the death was scathing: the woman should never have been allowed to move in; the staff had missed or ignored bulimic episodes and her obvious weight loss; no plan of care was ever developed or implemented despite the resident’s profound psychological problems.

Emeritus, asked to respond to the state’s investigation, said only that the woman had overdosed on drugs she had brought into the facility on her own, and that as a result they could not be faulted in her death.

“She Barely Even Talked to Us”



In the aftermath of her fall in September 2008, Joan returned to Emerald Hills. But the staff, inexperienced and often exhausted, worried about her.

“She couldn’t walk, she couldn’t feed herself, she barely even talked to us, and her health wasn’t that good,” recalled Jenny Hitt, a former medication technician at Emerald Hills.

But if concern was abundant at Emerald Hills, expertise was in short supply.
Alicia Parga ran Joan’s memory care unit. On some weekends, she managed the entire building — not only the wing of residents with dementia, but the rest of the three-story assisted living facility, one that could hold a total of more than 100 residents.

After Parga started on the job, it took Emeritus roughly 18 months to give her any training on Alzheimer’s and dementia. The state regulations were hardly substantial: Someone such as Parga was obligated to get six hours of training during her first four weeks on the job. But even that requirement wasn’t met.
Emeritus has insisted that Emerald Hills had properly trained personnel to care for Joan and others, and they described Parga as a woman deeply invested in tending to the residents.

But Parga, who had barely earned a high school degree, wasn’t even familiar with the seven stages of dementia. Though she was responsible for the well-being of 15 or more seriously impaired people, as well as the supervision of employees, Parga was paid less than $30,000 per year.

Catherine Hawes, a health care researcher at Texas A&M University, conducted the first national study of assisted living facilities. In her view, training is absolutely crucial. A well-educated employee can “interpret non-verbal cues” from people like Joan, intercept seniors before they wander away from the building, or keep residents from eating or drinking poisonous substances.
“You can do great care,” she said. “You just — you’ve got to know how.”
Other than the Emeritus employees working in the memory care unit at Emerald Hills, only one person saw Joan enough to know what kind of daily care she was getting: Her husband, Myron.

He was worried. And he did his best to sum up his concerns to his son Eric:
“They’re not treating Mom well.”



Jonathan Jones is a former religion reporter for MediaNews Group and is the son of a Presbyterian minister.