Assisted Living That Doesn’t Involve Real Estate

Wilma Stanley Items of Interest

The previous  post (The Pandemic has changed healthcare for good, and for the better) focused on changes in the delivery of acute medical care following a hospitalization.

But what about longer term care, for example, assisted living?

Joseph H Coughlin has written an article (This Senior Living Business Model Doesn’t Involve Real Estate that not only introduced me to the word "disintermediating", but to the acronym VAL - for "Virtual Assisted Living".  Although the article might be targeted towards the business community, it offers us insight into how assisted living services might be delivered within our community.  

"The pandemic experience and the evolving effectiveness of technologies is disintermediating the idea that care must be linked to place. Increasingly it will be all about the the capacity to provide quality services that are effective, affordable, and excite and delight wherever the older person (and their family) decides to call home."

These changes can also impact the delivery of assisted living services within our community - the place we decide to call home.

The Pandemic has changed healthcare for good, and for the better

Wilma Stanley Items of Interest

Ah, Online conferencing. It enabled us to meet with our co-workers, family, friends and fellow musicians during 2020 and 2021.   It also enabled us to keep some of our medical appointments.

Telehealth already existed in 2020, but most of us would not yet have experienced it were it not for the COVID-19 pandemic.  The desire to avoid the spread of COVID-19, combined with a change in Medicare/Medicaid home health regulations during the COVID-19 public health emergency, led to much quicker adoption of remote medical appointments than previously anticipated.

In June 2020, Centers for Medicare and Medicaid Services proposed to permanently finalize the amendment to the home health regulations that allowed telehealth to be covered under the Medicare home health benefit, beginning January 1, 2021.

Also in June 2020, Mayo Clinic announced a new at-home advanced care model, in a collaboration with Boston-based technology-enabled services company Medically Home.
https://www.healthcarefinancenews.com/news/mayo-clinic-announces-advanced-care-home-model-medically-home

“Using a new technology platform to enable this care-at-home framework, patients with conditions that once had to be managed in a hospital will have the choice to transition to a home-based setting, where they will receive a combination of virtual and in-person care, as well as recovery services.”

In May 2021, Mayo Clinic and Kaiser Permanente announced that they will collaborate to build capacity for “hospital-at-home” care.  They have invested $100 million in Medically Home Group.   These players are some heavy-hitters.
https://www.healthcareitnews.com/news/mayo-clinic-kaiser-put-100m-toward-hospital-home-care

https://www.forbes.com/sites/brucejapsen/2021/05/13/mayo-and-kaiser-invest-100-million-in-hospital-care-at-home-venture/?sh=3c35e9c26063

Medically Home describes it (short video)
https://www.youtube.com/watch?v=1d4XcdQqACA

Representatives from Medically Home, Kaiser, and Mayo Clinic announce this partnership in great detail with Q/A. (54 minute video):   https://www.youtube.com/watch?v=-hVxkH6OqXw

These changes not only promise the improvement of care to underserved areas, but they also mean that within a supportive community such as ours, hospital stays can be as brief as possible, with recovery among family and friends.

‘Zoom’ your partner! Fans of contra and square dancing have moved online.

Wilma Stanley Uncategorized

Some of us have figured out ways to play and sing FOR others using Zoom, or even WITH others using Jamulus, but apparently there are dancers who have found ways to DANCE remotely!

https://www.washingtonpost.com/local/contra-square-dancing/2021/04/27/11e192b4-a772-11eb-bca5-048b2759a489_story.html

In fact, Triangle Country Dancers Spring Dance Romance 2021 weekend is virtual this year, and about to begin (May 14-16). Triangle Country Dancers (tcdancers.org)

Building – Prefabricated Construction – Deltec

Wilma Stanley Uncategorized

We were introduced to Deltec Homes by way of Cozy Home Community™ (https://www.cozyhomecommunity.com/about/#deltec). “Cozy Homes are based on a housing unit designed and built by Deltec Homes of Asheville, NC.” (https://www.deltechomes.com/renew-collection/ridgeline-e-f/)

Deltec Homes designs homes for which they build the shell of prefabricated panels that are assembled locally at the building site. These panels are designed for high quality, low maintenance, energy efficient and environmentally responsible housing. https://www.deltechomes.com/learn-more/about-us/

Initially, Deltec Homes primarily built hurricane resistant round homes. Might our Arts Center be “in the round”?

Although Deltec Homes takes energy efficiency and environmental stewardship seriously, they clearly have a sense of humor. Enjoy their April Fools Day video: https://www.youtube.com/watch?v=5uz40RvqsmE

Designing a Community – CozyHomeCommunity

Wilma Stanley Uncategorized

One of 2T’s Mission goals is to build an affordable, environmentally sustainable community. That goal is shared by Matt Thornhill, Founder & CEO of Cozy Home Community™, with a target audience of “middle-income Boomers between the ages of 60 to 80+”. Energy efficient houses designed by Deltec Homes are clustered into Colonies (pocket neighborhoods) that are configured into multi-Colony Communities – with the emphasis on Community.

We look forward to meeting Matt soon to learn more about his vision, which has much in common with our own.
https://www.cozyhomecommunity.com/about

Building – Modular construction

Wilma Stanley Uncategorized

As we build a team to develop our new community, we have begun learning about builders and developers.

The pandemic has affected us all, and developers are no exception. This NYT article identifies advantages of modular construction as well as the types of projects in which modular construction is being used.

Modular Construction Meets Changing Needs in the Pandemic

Educating ourselves about what works (and what doesn’t.)

Bree Kalb Uncategorized

This NYT article is sobering and educational. Even the comment section has some useful information. We believe that aging in community, with a household model, will reduce and ameliorate the unpleasant and distressing experiences some have as they grow older and more frail.

Social connection rather than social isolation

Bree Kalb Uncategorized

Aging in Place is the first choice for many as they plan for their future needs.

We are a group of people who want to age in a warm and friendly community that feels like home and includes our favorite activities–music, dance, and other creative pursuits.

We continue to meet monthly to educate ourselves about our options. It’s a long process; we hope you’ll stay interested in our dreams as we learn more.

This article comes from a site that encourages and offers good advice to those who do decide to age in place. It takes an awful lot of effort to connect with others for those who make that choice.

We Continue to Move Forward!

Bree Kalb Items of Interest, Planning and Design

On June 26, 2018, Martin Dickmann of Action Pact presented the Integrated Business Plan (IBP) they developed for us as a result of six day-long meetings with our Founders.  A great deal of work has gone into the creation of this plan; much more work will be needed to craft a design and to begin construction.

Here is a summary of the IBP:

Our overall goal is to create an arts village that supports older adults, which we will build in two or three phases. It will eventually comprise 150 homes and 40 spaces for those who require a spectrum of health care.

 

 

 

Common amenities — will eventually include the following:

  • Community Center/Wellness Center
  • Dining Venues
  • Dance Hall/Auditorium
  • Household Model of skilled nursing care
  • Gardens/Greenspace
  • Studios, practice and teaching spaces
  • Outpatient clinic

Phase 1 will include the following:

  • 50 independent cottages, ranging in size from 750 to 1,500 square feet;
  • 6 Adult Care Home units, providing levels of assisted living as needed;
  • A Music and Dance Center.

We’ll add other amenities as finances allow.

We estimate that Phase 1 will cost $18.3 million.  Additional phases will be undertaken as resources permit.

The plan assumes that we create a new for-profit corporation (we’re calling it LandCo for now) to raise equity (investments from us), which will be used to carry out pre-construction activities: land acquisition, entitlement, legal, architectural, and engineering fees.

Loans will then be secured for construction (including site work).

LandCo will retain ownership of the Music and Dance Center, the Adult Care Home, and all common land. Homes will be sold on a fee simple basis to residents.

We will not have a licensed skilled care facility at this time, so Medicare or Medicaid will not reimburse for care. Individual Long-Term Care insurance policies might, however.

We initially intended to build a Continuing Care Retirement Community. The more we learned, the more complications we discovered. Getting a license is expensive, bureaucratically complex, and not guaranteed. We’d need to have a lot of money raised and held in escrow. There are, however, some creative ways to provide similar care without the CCRC designation (by purchasing existing licensed “beds,” for example).

Next steps in this journey include the following:

  • Form a development committee.
  • Create an initial investor offering for pre-development funding.
  • Solicit/secure initial investor commitments.
  • Create a developer RFP (Request for Proposal).
  • Carry out developer RFP process and developer selection.
  • Prepare a development plan that is site specific, simultaneous with site selection.

How long before we can move in? It depends on how quickly we can proceed and how long it takes us to raise the money we need to start. Estimates range from three to five years. The more flexible we are in our land choices, the sooner we can find land.

What we now have is a workable business plan, that allows for flexibility as we develop our community.

 

 

Do you or a loved one have Medicare?

The Editor Items of Interest, Uncategorized

Medicare provides a range of benefits for outpatient and inpatient care. But, an effort to prevent premature discharges from hospital stays has resulted in unintended consequences that can cost the patient thousands of dollars. We include information about this glitch in our Educational Workshops. NPR offers some even more detail. Some have found it effective to repeatedly insist on being admitted. A good reason to have a friend or relative as an advocate when going to the ER.

https://www.npr.org/sections/health-shots/2018/04/20/583338114/how-medicares-conflicting-hospitalization-rules-cost-me-thousands-of-dollars

Benefits of Dance, Music, Creativity and Social Contact

The Editor Items of Interest, Uncategorized

Here’s a NYT article with good information about aging well, including dancing.

https://www.nytimes.com/guides/well/how-to-age-well

And this article is specifically about the effects of contra dancing. ” A new study that compared the neurological effects of country dancing with those of walking and other activities suggests that there may be something unique about learning a social dance.”

https://www.nytimes.com/2017/03/29/well/walk-stretch-or-dance-dancing-may-be-best-for-the-brain.html

 

Reference Guide to all CCRCs in N.C.

The Editor Items of Interest, Uncategorized

Here’s a link to an incredibly informative Reference Guide from the NC Insurance Commissioner’s office, comparing ALL the licensed CCRC’s in the entire state!
You probably don’t want to peruse all 99 pages. These are the pages we identified as most useful in the 2016 guide; we think they are numbered the same in this year’s version:
pdf pp. 4-8: explanation of terms
pdf p 9:  map and names (with reference numbers) of all NC CCRC’s
pdf pp 68-71:  summary of contract and refund options
pdf pp 71-74:  summary of other services and features
To find an individual CCRC pdf page, add 9 to its map number.
We recommend that you check the map on p. 9; look at and compare the ones in Durham, Chapel Hill, Raleigh, and perhaps Burlington and Greensboro, as well as Pennybyrn (#27, pdf p. 36), which uses the Household model.  In addition, the fee ranges on the individual pages can give you a sense of current local pricing.
When you click on the link it may automatically download the PDF to your computer, depending on your settings.

Home Funeral and Death Care Midwife Training – The Center for End of Life Transitions, May 2016

The Editor Items of Interest, Uncategorized

Based in Western North Carolina, the Center for End of Life Transitions offers Home Funeral Guidance and Assistance, as well as End of Life Educational Opportunities through workshops and retreats. See the website at: http://ceolt.org/

 

Information about upcoming workshops: http://ceolt.org/events/home-funeral-and-death-care-midwife-training/

Book and Film Recommendations, April 2016

The Editor Items of Interest, Uncategorized

Both this book and DVD reflect the philosophy and motivation of the Traditional Music and Dance Retirement Society and our pioneering vision of how we want to live in old age.

Many of us have seen a clip from ALIVE INSIDE; now the entire film is available to purchase or to stream from Netflix or I-tunes.

ALIVE INSIDE is a joyous cinematic exploration of music’s capacity to reawaken our souls and uncover the deepest parts of our humanity. Filmmaker Michael Rossato-Bennett chronicles the astonishing experiences of individuals around the country who have been revitalized through the simple experience of listening to music. His camera reveals the uniquely human connection we find in music and how its healing power can triumph where prescription medication falls short.

This stirring documentary follows social worker Dan Cohen, founder of the nonprofit organization Music & Memory, as he fights against a broken healthcare system to demonstrate music’s ability to combat memory loss and restore a deep sense of self to those suffering from it. Rossato-Bennett visits family members who have witnessed the miraculous effects of personalized music on their loved ones, and offers illuminating interviews with experts including renowned neurologist and best-selling author Oliver Sacks (Musicophilia: Tales of Music and the Brain) and musician Bobby McFerrin (“Don’t Worry, Be Happy”). An uplifting cinematic exploration of music and the mind, ALIVE INSIDE’s inspirational and emotional story left audiences humming, clapping and cheering at the 2014 Sundance Film Festival, where it won the Audience Award.

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Being Mortal, by Atul Gawande, is groundbreaking and brilliant. Many of you have already read it. If not, this might pique your interest.
Here’s a summary from a NYT review and a link to the full review. This should be easy to find at your local book store.

“Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.  It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”