“It’s what I call the ‘not enough rich old people’ problem,” said Bob Applebaum, director of the Ohio Long-Term Care Research Project with the Scripps Gerontology Center.
Assisted living occupancy in Ohio is down from 89% to 86%, according to Applebaum, who testified last week in front of an Ohio House committee on elderly issues.
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Assisted living facilities are mostly a cash-pay service, though there’s a program about 4,000 to 5,000 Ohioans use that lets people covered by Medicaid receive a waiver to pay for assisted living services. Otherwise a unit can cost about $4,000 or more a month.
The services at assisted living facilities can vary significantly between locations but generally include meals, housekeeping, social events, help with medication and help with personal care.
Medicaid
Medicaid pays less for assisted living services than the facilities can charge cash paying residents, which Applebaum said is one factor to understanding supply and demand.
“The amount of money we’re paying for the Medicaid wavier for assisted living has been pretty much flat since the waiver was passed in 2007,” he said.
The population has been aging and that’s been increasing demand for these facilities — there will be a projected increase of 3.2 million people in the U.S. over age 80 between 2017 and 2025. Assisted living facilities have also been attracting people who years ago would have lived in a nursing home.
In the Dayton region, there there’s a waiting list for people the Area Agency On Aging is working with who want to use Medicaid at an assisted living. Communities often make allowances for long time assisted living residents who run out their savings, but the facilities don’t always have beds open for new people with Medicaid to move in.
“Probably the toughest person to get into assisted living on Medicaid is an individual who is moving from a community setting to assisted living,” Doug McGarry, the agency’s executive director, said.
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Pete Van Runkle, CEO of the Ohio Assisted Living Association, said assisted living facilities limit or don’t accept Medicaid because the pay is too low, though the state is proposing a 3.2% increase.
“If they take waiver at all, which many don’t, they tend to limit the number of people they will take,” Van Runkle said.
Deborah Shuler said her father had been in assisted living in several different places. He started out at an independent living apartment but eventually needed a higher level of care. She said they wanted the assisted living facility to be close to family so they could easily visit, so location was important.
She said her father, Don, who died in 2015, was a naval officer in World War II and had V.A. benefits to help afford where he lived. But she said there still needs to be more affordable housing for seniors.
“These new places are tapping into the upper 10% of society. They are going after people with money and assets, because if you don’t have a lot of money you can’t live at these places,” Shuler said.
Shannon Burton, marketing administrator with Tapestry Senior Living, opened in July in Springboro is unique in the area because it was funded with the Low-Income Housing Tax Credit program, which funds affordable housing.
Because of the program, the 118-unit building rents based on income and Burton said staff meet with patients to see if there are extra benefits they qualify for, such as if they are a veteran. They also accept the Medicaid waiver for about 25 of the apartments.
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About 40 residents have moved in and 17 more are planning to.
She said she’d advise people ask a facility if they take the Medicaid waiver if they can guarantee they will accept the waiver or if the resident could be waitlisted.
“You’re going to want to ask more questions,” Burton said.
Location, location, location
There’s also the matter of where the facilities are concentrated.
“Everyone that wants to build assisted living wants to build it in fancy neighborhoods. Nobody wants to really build it in less affluent areas,” Applebaum said.
Some of these recent assisted living projects in the area include the 73-unit Crescent Crossing, which Graceworks Lutheran Services opened one year ago on the Bethany Village senior living campus in Centerville. It replaced a smaller wing.
In Beavercreek, HarborChase opened at 4175 Indian Ripple Road in early 2019 with 110 apartments and three years before that Traditions of Beavercreek opened on 800 Grayson Lane.
In November, Warren County approved a 10-year, 50% tax abatement for the planned Traditions of Lebanon, which will have 142-unit assisted living complex, including 30 units for memory care. The project is planned just south of the Franklin Road-Ohio 123 intersection with Neil Armstrong Way.
In 1993, when Applebaum said his team started tracking residential care facility beds, there were fewer than 10,000 beds in Ohio. While there’s not an official designation for assisted living in Ohio, most of the “residential care facility” beds are assisted living. Now there’s more than 55,000 beds. That’s a faster growth rate than Ohio’s population, which went from 11 million to 11.7 million along that same time frame.
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McGarry said the supply of new assisted living facilities also raises questions about the supply of workers for these facilities.
“As new facilities come on are they bringing newly trained workers to the field or are they expecting to recruit workers that are currently employed elsewhere and to what impact?” he said.
McGarry said some of the locations where these are in demand and being built, such as the outer suburbs, are places that can be hard for workers to get to, especially lower wage workers taking public transportation.
“Workers in long-term care tend to be primarily female, have transportation limitations and tend to live in less affluent areas. So when you open in a more affluent area, immediately there’s concern of how does the worker get there?’” McGarry said.
How to shop for the right place
As increasing number of new assisted living facilities compete for new residents, several readers who called the Dayton Daily News had some advice.
June Sloan said her husband Robert had lived at Brighton Gardens, which she said was a good fit and, importantly, was close to her so she could visit.
She’d recommend asking friends for their recommendations, visiting many places, and finding one close to family so they can visit. She said you should see if the staff greet you and treat you with respect, friendliness and dignity, and see if there are many social events, and see if they food is good. Take a tour, but also stop by unannounced to check it out.
“Dropping in at varied times will allow you to see if there is the help staff that you were promised,” Sloan said.
She also said it’s important that the place looks clean and organized and people should ask questions on whether they can stay in their home if their condition gets worse, or if they will have to leave and go to another place if their abilities change and they need more care.
She said there were several groups in the area like the Alzheimer’s Association and Area Agency on Aging that were helpful.
Where to get help
Area Agency on Aging
The Area Agency on Aging can provide a free in-home assessment and see if you are eligible for the Assisted Living Waiver programs or other community resources. Clark, Greene, and Montgomery County Residents can call 223-HELP or 800-258-7277, or email aaa@info4seniors.org. Champaign, Darke, Logan, Miami, Preble, and Shelby County residents Contact Catholic Social Services of the Miami Valley at 800-521-6419 or email referrals@cssmv-sidney.org.
Long-term Care Ombudsman
The Long-term Care Ombudsman program can help people with selecting the right provider, including an assisted living facility.
The Dayton office can be reached at 937-223-4613 or 1-800-395-8267 and serves people in Montgomery, Preble, Greene, Clark, Miami, Darke, Logan, Shelby, and Champaign Counties. The ombudsman’s office serving Butler, Clermont, Clinton, Hamilton, and Warren counties can be reached at 513-458-5518 or by emailing helpline@proseniors.org and put “Helpline” as the subject.
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