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long-term care infrastructure op-ed in The Hill

America’s long-term care infrastructure: A road to nowhere – Op-ed in the Hill co-authored by Nexus Insights

In a recent op-ed in The Hill, Nexus Insights Fellows Anne Tumlinson, David Grabowski and Robert Kramer, raise an important point that has been missing from recent discussions around transforming long-term care following the pandemic. The Biden Administration has proposed a $400B investment in home- and community-based services (HCBS). We assert this investment is necessary but not sufficient. Without additional spending on services to help families navigate and manage long-term care services, this HCBS investment is basically a “road to nowhere.” We argue for the need to create a network of long-term care service hubs across the country to help families navigate services.

As you know, there have been A LOT of thought pieces around improving long-term care going forward, but we have not seen this point made elsewhere. Thus, we believe it would be an ideal time to make this point as policymakers consider the Biden proposal.

Excerpt:

Long-term care is complex. Few Americans plan ahead and most wait until a crisis pushes them into a frantic search for solutions. It doesn’t have to be this way.

Every day older adults lose their ability to care for themselves. Often, they are discharged from the hospital too weak or confused to be left alone or care for themselves. Now what? Who will take care of them? Is home- or facility-based care the best option? How much will it cost and who will pay? Does Medicare cover it? Does Medicaid? If home care is the answer, how do you find a qualified and affordable caregiver? Where do you even start? Life-changing decisions must be made, and fast.

Read the full op-ed in The Hill.


Anne Tumlinson is CEO of ATI Advisory and the Founder of Daughterhood. David Grabowski is Professor in the Department of Health Care Policy, Harvard Medical School. Robert Kramer is the founder of Nexus Insights, and the co-founder and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing & Care (NIC).

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Update on Nexus Fellow May 21s

Nexus Fellow Flash Feature: May 2021

As the United States shifts gears from pandemic crisis management to a new post-COVID normal, we must now deal with the aftermath and identify what went wrong and what we can do better. Issues of transparency and loneliness in nursing homes linger. Large corporations that once were oblivious to the older population have found a new market. How will we address the age-old problem of social connection for those who are still isolated, a problem seniors have faced for decades? The entire industry, the way we view older adults, the options for living independently and the implementation of technology, must all be urgently addressed and thoughtfully designed into an actionable plan for the future of aging and longevity.

Our Fellows continue to strive for innovation and reform. Here’s what they’ve been up to:

NEWS:

  • Nexus Fellow David Grabowski, was quoted in an article by the Associated Press on nursing homes’ requirement to report COVID-19 vaccinations at nursing homes. “This is an important development that is months overdue,” said David Grabowski, a Harvard health policy professor who has tracked the industry’s struggles with the outbreak. “Many of us argued that this information should have been published starting in December when the federal long-term care vaccination effort began.”

 

  • Dr. Bill Thomas, Nexus Fellow and creator of The Eden Alternative, Minka, and the Green House Project, is helping value-based care innovator Lifesprk (which acquired Tealwood Senior Living.) Dr. Thomas will be leading the efforts to combine the two companies’ operations. He has also created Kallimos Communities, new multi-generational communities with small dwellings clustered around shared green space. Additionally, he has a new project he’s working on with Signature Healthcare — currently called “Canopy” — a cluster of small ADA-accessible houses built close together.

 

  • Bob Kramer, Founder and Fellow of Nexus Insights, was interviewed by Nancy Griffin for SeniorTrade Blog. He defines 5 Boomerville Segments likely to flourish in the future: Wellnessville, where residents will focus on healthy lifestyle, diet and exercise; Margaritaville, resort-style independent living (Minto Communities’ Latitude Margaritaville has three wait-listed locations with more in development); Serviceville, where the emphasis is on volunteerism, mentorship and giving back; Collegeville, where residents focus on continued learning in a communal living environment, and Changeville, for those concerned with making a difference in the world and creating a legacy.

 

  • Preordering is now available for “Right Place, Right Time, a book by Nexus Fellow and CEO of SmartLiving 360, Ryan Frederick. “Place plays a significant yet often unacknowledged role in health and happiness. The right place elevates personal well-being. It can help promote purpose, facilitate human connection, catalyze physical activity, support financial health, and inspire community engagement.”

 

  • Nexus Fellow Kelsey Mellard, CEO of Sitka, sat down with Sanjula Jain Jo on Her Story for a candid conversation about being a healthcare leader and her transition from the Midwest to DC to Silicon Valley, building a resilient team, and overcoming challenges.

 

  • Will seniors continue to buy groceries online post-pandemic? Nexus Fellow Jody Holtzman, longevity economy expert, formerly of AARP, thinks seniors will split their shopping, using online for staples such as canned goods and going into stores for fresh foods. Some senior consumers claim it’s a social outlet for them. “As the necessity imposed by the pandemic lessens,” Holtzman says, “retailers will have to start to play the price game.” Read more at Blomberg.com.

 

Out and About:

  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, and Nexus Insights Fellow, recently spoke at a session, “Finding success in increasing diversity and inclusion,” at the 2021 Women of Distinction educational webinar. We’d also like to congratulate Jill on joining the SeniorTrade Advisory Board.

Jill Vitale-Aussem joins SeniorTrade Advisory Board

  • On June 30, Nexus Fellow Sara Zeff Geber will be joining experts and thought leaders in the areas of aging, retirement and thriving for the “Boomers Thriving After the Pandemic” virtual summit, hosted by Wendy Green from Hey, Boomer. Other speakers include Helen Dennis and John Tarnoff. Part of the proceeds will go to Meals on Wheels Greenville and The Walk to End Alzheimer’s. For more info visit the virtual summit’s Eventbrite page.

Sara Zeff Geber on Hey Boomer

  • Sarah Thomas, CEO of Delight by Design and Nexus Fellow, recently presented at the Rehab Tech Summit sponsored by AARP Innovations Labs. She spoke about designing for all, including age tech, universal design, living with purpose and designing beautiful products for everyone at every age.

 

COMPANIES ON THE MOVE:

  • Jay Newton-Small, CEO of MemoryWell, is growing MemoryWell. After a successful capital raise, she’s been adding some amazing new talent to her team including Sarah Jones from Healthsense, GreatCall and Best Buy Health.

 

  • Jacquelyn Kung, CEO of Senior Care Group at Activated Insights, is working with her team to create recognition programs for senior care providers, based on their resident and family surveys. The goal is to tie the data to outcomes and impact metrics, and to use machine learning to identify patterns in those who improve to apply across a broader population of providers.

 

NEW RESEARCH:

 

 

VIDEO DISCUSSIONS:

 

 

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Bob Kramer and Anne Tumlinson discuss HCBS

Foresight TV: Bob Kramer & Anne Tumlinson – What Does HCBS Mean For LTC?

With the federal government considering an investment in the country’s infrastructure, a new light has been shed on the importance of infrastructure. And from the resulting discussion, a broader understanding of what is vital infrastructure is emerging. That infrastructure necessarily includes a system of long-term care for the nation’s aging population and a trained workforce to deliver that care.

“We have an outdated, crumbling infrastructure in nursing homes. We have non-existent infrastructure in home and community-based services (HCBS). And we have millions of older adults living longer, many of whom will need services and supports,” said Bob Kramer, Founder and Fellow for Nexus Insights, and Co-Founder and Strategic Advisor for the National Investment Center for Seniors Housing & Care (NIC).

Kramer recently interviewed long-term care expert Anne Tumlinson about the importance of long-term care and changes needed in how it’s delivered and how it’s paid for. Tumlinson, the Founder and CEO of ATI Advisory, and Founder of daughterhood.org, offered recommendations for the policy changes needed to make long-term care financially viable for more seniors and their families. Her recommendations also addressed the critical need for a living wage for the shrinking pool of caregivers who work in long-term care, and the important role of HCBS in helping seniors thrive.

“We don’t have a system; instead, every single family has to create their own system, over and over again. What is out there that could help me? How do I find it, set it up, coordinate it? There is currently no system or function in our society to handle that,“ said Tumlinson.

The interview was hosted by Senior Living Foresight. View the entire discussion.

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LTSS caregiver and patient

ATI Advisory Issues Recommendations for Expanding Access to Home and Community-Based Services

Long-term services and supports (LTSS) when provided in the community as home and community-based services (HCBS) can be a lifeline to help a person live safely at home and age with dignity. In a position paper on HCBS, A Blueprint for Reforming Medicaid Long-Term Services and Supports and Creating Good Caregiving Jobs, ATI Advisory CEO, and Nexus Fellow, Anne Tumlinson offered three recommendations for legislators and regulators to expand access to home-based care services sustainably and equitably. 

1 – Providing states with better financial support, assurances and predictability

Medicaid accounts for 29% of total state spending across all funding sources, and LTSS is a substantial portion of this spend. This creates financial pressures, resulting in cuts to the Medicaid program during times of budget pressure, and reluctance to provide or expand services that are optional, such as HCBS LTSS. 

IMMEDIATE RECOMMENDATIONS: Several policy and financing approaches (e.g., enhanced federal match for HCBS, state education on HCBS financial controls) increase access to HCBS by increasing funding and alleviating immediate state financial concerns.

LONGER-TERM RECOMMENDATIONS: Financing reform could include federalizing some portion of LTSS or creating a shared risk model between states and the federal government. 

Read the full recommendation

2 – Modernizing long-standing Medicaid eligibility policies

Long-standing Medicaid eligibility policy creates a bias toward institutional care, making it difficult for individuals to remain in their home or the community when they have LTSS needs. 

IMMEDIATE RECOMMENDATIONS: Several eligibility regulatory changes would increase access to HCBS and help ensure individuals have access to LTSS in the most appropriate setting of care. 

LONGER-TERM RECOMMENDATIONS: National minimum eligibility standards applied across states would reduce inequity and improve access.

Read the full recommendation

3 – Investing in the direct care workforce delivering HCBS

Immediate and longer-term recommendations for increasing access to home and community-based services (HCBS), reducing institutional bias in Medicaid long-term services and supports (LTSS), and creating good caregiving jobs: 

ISSUE: Direct care worker pay is relatively low and the work is demanding. Policymakers should take a comprehensive approach to fairly compensate; elevate; and retain, engage, and develop workers. 

SHORT-TERM RECOMMENDATIONS: Increase the minimum wage, create a high-level HCBS and Direct Care Workforce coordinating office, make targeted investments in training, and launch a public service campaign to help address key workforce issues. 

LONGER-TERM RECOMMENDATIONS: Improve jobs by enacting policies to support affordable childcare, healthcare, and paid sick leave; modernize training; and create a permanent federal Center for Direct Care Excellence. 

Read the full recommendation

 

See the full Position paper

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Nexus Fellow

Nexus Fellow Flash Bulletin – March 2021

COVID has caused dramatic disruption in our education and healthcare systems and long term care environments. We wear masks, we distance, we stay home. So what have we learned? How can we come out stronger on the other side? Despite the massive challenges and barriers to implementation, there is a strong sense of hope on the horizon.

“Out of the tragedy of COVID, there are a lot of silver linings, a lot of good things we’re learning. Let’s seize the opportunity from the crisis so we can say we learned from it, and we won’t be here a year or two from now saying that nothing is different.” Nexus Founder & Fellow, Bob Kramer

While the pandemic has had a devastating impact on the seniors housing and long-term care industry, it’s also shed a big spotlight on this industry like never before. And that has advantages. After all, how could anyone identify a problem if they aren’t looking. People are paying attention now, and if we take this opportunity and make the changes needed, the senior living and long-term care industry will vastly improve post-pandemic.

Our Nexus Fellows are front and center. They’re experts, thinkers and entrepreneurs, bringing fresh ideas and important insights to the industry at this critical time. 

What’s the latest? Here’s a Nexus Fellow Flash Bulletin:

  • Bob Kramer, Founder and Fellow of Nexus Insights joined Jocelyn Dorsey, Becky Kurtz, Elise Eplan and Deke Cateau on a panel last month for A.G. Rhodes Living Well-Virtual to discuss the stark realities of what is happening with COVID19, aging, and in the senior housing world. “What became clear in our conversation is that, despite the overwhelming challenges and difficulty in pandemic protocols and vaccine strategies, there was a sense of hope throughout.
  • Nexus Fellow Kelsey Mellard, CEO of Sitka, announced that Sitka has raised $14 million in Series A financing led by Venrock, with participation from existing investors Optum Ventures, Homebrew, First Round Capital, and Lifeforce Capital. This round of funding will enable Sitka to accelerate product development and expand growth with new and existing partners.
  • Jill Vitale-Aussem, president and CEO of Christian Living Communities, and Nexus Insights Fellow, was featured in a McKnight’s Senior Living piece on how the senior living industry needs to change. “We need meaningful purpose in our lives. We don’t need to live in a hotel. We need to belong…to continue growing and learning…I am a huge proponent of shifting our thinking of residents as customers, which really creates helplessness, and moving to a model of citizenship”
  • In an op-ed piece in The Dallas Morning News, Jacquelyn Kung, CEO of Senior Care Group at Activated Insights and a Nexus Insights Fellow, with Nexus Insights Founder and Fellow Bob Kramer and author Ed Frauenheim offered five practical solutions for “repairing and renewing the industry.”
  • In a recent interview, Nexus Fellow Jody Holtzman cited four important trends to consider as we embark on a rebuild of a broken industry. Three of them are driving a changing view of health: the expanding holistic view of health that started with a focus on social determinants; the growing list of non-traditional supplemental benefits reimbursed by CMS; and, the increasing centrality of the home as the locus of health, care, and connected living. These are tempered however by a counter-trend: the slow uptake and limited usage of new supplemental benefits.
  • In a recent article for the journal Health Affairs, Nexus Fellow David Grabowski, along with Charlene Harrington, Anne Montgomery, Dr. Terris King, Sc.D., and Mike Wasserman, discussed recommendations for changes to public policy that would “make ownership, management, and financing more transparent and accountable to improve US nursing home care.”
  • In his latest piece on the SmartLiving 360 blog, Nexus Fellow Ryan Frederick explains that while Zillow provides comprehensive information about homes to purchase or rent, it can’t answer the question of what happens when you lose electricity and water for days, as happened in Texas recently. Whether neighbors come together as a community to help each other through the crisis has a big impact on whether you’ve chosen the right place to live.
  • Sarah Thomas, CEO of Delight by Design and Nexus Fellow, was keynote speaker at the Rehab Tech Summit in February. In her speech titled, Designing the Future: Creating Your Own Path Through a Lens of Innovation, she said,  “It’s time we challenge our own views on aging. As we design products, services, spaces and communities we must design for ALL. Our designs should delight our consumers at every age. It was such a pleasure to share my professional journey that has taken me around the world changing the global perspectives on aging.”
  • Caroline Pearson recently completed a project looking at consumer experience measures for Medicare Advantage plans. The report recommendations holding plans accountable for aspects of consumer experience that are meaningful to beneficiaries and within the health plans’ control to improve. Caroline’s team at NORC continues to examine the impact of COVID-19 on older adults in seniors housing. Look for their report due out soon.
  • Dr. Bill Thomas will be featured in the 30th Annual Aging Well Conference hosted by the University of Wisconsin-Parkside Professional and Continuing Education Office on April 23 & 30. In his keynote, Dr. Thomas will deliver a multi-part interactive keynote “What if Everything we Know About Aging is Wrong?” followed by a Q&A session. In his breakout session “MAGIC:  Exploring Intergenerational Communities,” Dr. Thomas will share new concepts in Multi-Ability, Multi-Generational, Inclusive Communities that brings together people of different ages, abilities, and backgrounds.

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Events

Foresight TV with Anne Tumlinson & Bob Kramer

Join Anne Tumlinson, CEO of ATI Advisory, and Nexus Fellow, and Bob Kramer, Nexus founder & Fellow, on a special Wednesday episode of Foresight TV hosted by Senior Living Foresight. Steam live via YouTube.