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FM","link":"/"}},"stateofhealth_206810":{"type":"posts","id":"stateofhealth_206810","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"206810","score":null,"sort":[1467822616000]},"guestAuthors":[],"slug":"its-covered-now-talking-to-your-doctor-about-end-of-life-care","title":"It's Covered Now: Talking to Your Doctor About End-of-Life Care","publishDate":1467822616,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n","blocks":[],"excerpt":"A new health benefit available to millions of Californians encourages people to discuss end-of-life care options with their doctors.","status":"publish","parent":0,"modified":1467759897,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1082},"headData":{"title":"It's Covered Now: Talking to Your Doctor About End-of-Life Care | KQED","description":"A new health benefit available to millions of Californians encourages people to discuss end-of-life care options with their doctors.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"It's Covered Now: Talking to Your Doctor About End-of-Life Care","datePublished":"2016-07-06T16:30:16.000Z","dateModified":"2016-07-05T23:04:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"206810 http://ww2.kqed.org/stateofhealth/?p=206810","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/06/its-covered-now-talking-to-your-doctor-about-end-of-life-care/","disqusTitle":"It's Covered Now: Talking to Your Doctor About End-of-Life Care","nprByline":"Emily Bazar\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/206810/its-covered-now-talking-to-your-doctor-about-end-of-life-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Millions of Californians are newly eligible for a health care benefit that could determine the treatment they receive in their final days — and most don’t know it.\u003c/p>\n\u003cp>Medi-Cal, which covers more than 13 million Californians, and Medicare, \u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">with more than 5 million\u003c/a> California enrollees now pay for “advance care planning” discussions with doctors.\u003c/p>\n\u003cp>Advance care planning isn’t about long-term care options, such as nursing homes or assisted living.\u003c/p>\n\u003cp>It’s about “your wishes for your care if you are not able to speak for yourself,” said Helen McNeal, executive director of the \u003ca href=\"https://csupalliativecare.org/\" target=\"_blank\">California State University Institute for Palliative Care\u003c/a>.\u003c/p>\n\u003cp>“If you’re incapacitated, if you need someone to speak for you, who do you want to speak for you? And what would be your medical wishes?” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If, for instance, you have a stroke that leaves you unconscious and unable to communicate, with little hope for improvement, would you want to be kept alive with a feeding tube and or ventilator?\u003c/p>\n\u003cp>“These decisions may have consequences for the quality of life you have for the rest of your life. They may also have consequences for whether you live or die,” McNeal said.\u003c/p>\n\u003cp>In other words, they’re important. But many doctors and patients don’t yet realize that talking about these decisions — and possibly putting them into writing — is a covered benefit.\u003c/p>\n\u003cp>Starting in October, Medi-Cal — the state’s version of the federal Medicaid program for low-income residents — began covering advance care planning discussions between doctors (or other qualified providers) and patients (or a family member), said Tony Cava, spokesman for the state Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>Any Medi-Cal recipient can use the coverage regardless of age, he said. Doctors can bill for the conversation twice a year per patient — plus an additional 30 minutes for one of the conversations — before they have to seek authorization for more coverage.\u003c/p>\n\u003cp>Medicare, the federal health insurance program for people 65 and older, and for people younger than 65 who have certain disabilities, started covering the discussions on Jan. 1. \u003ca href=\"https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf\" target=\"_blank\">Medicare does not limit\u003c/a> the number of discussions per patient each year.\u003c/p>\n\u003cp>Some private insurance plans cover these discussions and some don’t, McNeal said. Check with your plan.\u003c/p>\n\u003cp>Both Medicare and Medi-Cal will cover the conversations even if patients don’t end up completing an “\u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000472.htm\" target=\"_blank\">advance care directive\u003c/a>” as a result. That’s a document that formalizes your wishes, which should be shared with your family and doctor.\u003c/p>\n\u003cp>McNeal believes that anyone over 18 should have this discussion and complete an advance directive.\u003c/p>\n\u003cp>But don’t expect your doctor to initiate the conversation.\u003c/p>\n\u003cp>“Many physicians may not be very comfortable having this conversation,” said Dr. Richard Thorp, president of the Paradise Medical Group near Chico, and past president of the \u003ca href=\"http://www.cmanet.org/\" target=\"_blank\">California Medical Association\u003c/a>, which represents the state’s doctors.\u003c/p>\n\u003cp>\u003ca href=\"http://www.jhartfound.org/news-events/news/advance-care-planning-poll\" target=\"_blank\">A poll of more than 700 doctors\u003c/a>, released in April, found that nearly half of them feel unsure some or much of the time about what to say when discussing end-of-life care with patients. (The poll was commissioned in part by the California Health Care Foundation. California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>Thorp’s patients are mostly older, so he incorporates advance care planning into their annual \u003ca href=\"https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html\" target=\"_blank\">Medicare Wellness exams\u003c/a>. Medicare reimburses him about $86 for the initial 30-minute discussion, and about $75 for each additional 30 minutes, he said.\u003c/p>\n\u003cp>“There’s an art to having the discussion,” he said. “There’s an art to recognizing when people are uncomfortable.”\u003c/p>\n\u003cp>McNeal’s institute, in partnership with the \u003ca href=\"http://coalitionccc.org/\" target=\"_blank\">Coalition for Compassionate Care of California\u003c/a>, offers online training for doctors about advance care planning. One course specifically focuses on \u003ca href=\"https://csupalliativecare.org/programs/advance-care-planning/fundamentals/\" target=\"_blank\">how to have an effective conversation with patients\u003c/a>.\u003c/p>\n\u003cp>Because many doctors don’t know about this benefit — or may feel uncomfortable broaching the topic — most people should start by \u003ca href=\"http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html\" target=\"_blank\">having a conversation\u003c/a> with family and loved ones, suggested Mark Beach, an AARP spokesman based in Sacramento.\u003c/p>\n\u003cp>After your discussion, write down your wishes, he said.\u003c/p>\n\u003cp>“It’s difficult to discuss, but when you’ve done it, it’s a comfort,” Beach said. “Not only will your wishes be followed, but your loved ones will know what to do.”\u003c/p>\n\u003cp>A variety of forms and templates are available to consumers. Thorp sometimes uses what’s called a “\u003ca href=\"http://www.polst.org/advance-care-planning/polst-and-advance-directives/\" target=\"_blank\">POLST\u003c/a>” form, which is \u003ca href=\"http://www.polst.org/advance-care-planning/faq/\" target=\"_blank\">a medical order\u003c/a> that must be completed and signed by a health care professional.\u003c/p>\n\u003cp>It is typically for seriously ill or frail patients, McNeal said, whereas an advance care directive is a legal document for people of any age or condition.\u003c/p>\n\u003cp>McNeal recommends the “\u003ca href=\"https://agingwithdignity.org/five-wishes\" target=\"_blank\">Five Wishes\u003c/a>” form, which can be personalized and is available online for $5 at \u003ca href=\"http://www.agingwithdignity.org/\" target=\"_blank\">www.AgingWithDignity.org\u003c/a>. Other options for advance directives can be found at \u003ca href=\"http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289\" target=\"_blank\">www.CaringInfo.org\u003c/a> or \u003ca href=\"http://bit.ly/28TtVVy\" target=\"_blank\">through AARP\u003c/a>. (A lawyer can help you prepare an advance directive, but you usually don’t need an attorney to get it done.)\u003c/p>\n\u003cp>After you have filled out your advance care directive, take it to your doctor and tell her you want to talk with her about it, McNeal said. Don’t forget to give your doctor a copy.\u003c/p>\n\u003cp>“The role of the physician is really to provide information, not to persuade one way or the other,” Beach said.\u003c/p>\n\u003cp>Thorp explains to his patients what it means to be intubated, fed artificially and kept on life-support.\u003c/p>\n\u003cp>Most are open to the discussion, he said, and their responses are mixed. Some older or sicker patients tell him they don’t want any extraordinary measures if they’re incapacitated. Others, who are younger and healthier, say they would probably want medical intervention if they might have a chance to thrive afterward.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most people don’t want to be kept on life-support indefinitely. They really don’t want that,” Thorp said. “They want to live a productive life.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/206810/its-covered-now-talking-to-your-doctor-about-end-of-life-care","authors":["byline_stateofhealth_206810"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_186","stateofhealth_40","stateofhealth_2519"],"featImg":"stateofhealth_206835","label":"stateofhealth"},"stateofhealth_174700":{"type":"posts","id":"stateofhealth_174700","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"174700","score":null,"sort":[1461083674000]},"guestAuthors":[],"slug":"secrets-of-getting-to-your-90s-in-good-health","title":"Secrets of Getting to Your 90s -- in Good Health","publishDate":1461083674,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>When it comes to getting old, some of us are a lot better at it than others. If I'm going to live to be 95 I would much prefer to be healthy, cogent and content. So I want to know the secrets of the healthy and very old.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The good news is that there's a lot we can do about it.' \u003ccite>Dr. Luigi Ferrucci, National Institute on Aging \u003c/cite>\u003c/aside>\n\u003cp>Fortunately, scientists are starting to figure that out, \"The good news is that there's a lot we can do about it,\" says \u003ca href=\"http://www.grc.nia.nih.gov/branches/irp/lferrucci.htm\">Dr. Luigi Ferrucci\u003c/a>, a geriatrician and scientific director at the National Institute on Aging. He wants to see more and more people in that state of \"aging grace.\"\u003c/p>\n\u003cp>I've been thinking a lot about what makes for a robust old age because my dad just turned 95. On his birthday, he pruned trees in the yard, took a walk, played a little online solitaire and had dinner with the family. We stayed up late and laughed a lot. Last week he did his taxes — the old-fashioned way, with a pencil, a calculator and a stack of IRS forms.\u003c/p>\n\u003cp>Clearly Dad has genetics in his favor; his father lived to be 97. But genes aren't fate, Ferrucci says: \"There's some destiny; we are children of our genome and what we inherit from our parents. But we can do a lot to avoid the destiny that was predisposed to us.\"\u003c/p>\n\u003cp>Studies have found that genes are a factor in extreme longevity just about 20 percent of the time, but being physically healthy while very old is much more likely to run in families. Clearly those families must be doing something right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"FYzaUlcNufiWHLdwWvVqjxWoXrX2czUt\"]To find out, in 2009 the NIH launched the \u003ca href=\"https://www.nia.nih.gov/health/publication/healthy-aging-lessons-baltimore-longitudinal-study-aging/blsas-ideal-future\">IDEAL\u003c/a> study, which focuses on the families of people who were able to delay or evade ill health in their 80s and beyond.\u003c/p>\n\u003cp>They've already gotten some physiological clues. Healthy old people are much more likely to have a lower resting metabolic rate, Ferrucci says, which means that their bodies are still working efficiently. \"They have energy left for other activities,\" he says. \"It allows them to do many, many things during daily life.\"\u003c/p>\n\u003cp>The lucky ones also tend to have fasting glucose numbers more typical of people in their 20s. Obesity and lack of exercise increase the risk of insulin resistance, so keeping weight under control and staying active from early adulthood can help there, Ferrucci says. Medications like metformin for people with insulin resistance help, too. \"There's a lot you can do to manage your insulin resistance as soon as you realize it's there.\"\u003c/p>\n\u003cp>Other studies, including the landmark \u003ca href=\"https://www.blsa.nih.gov/\">Baltimore Longitudinal Study on Aging\u003c/a>, have found that participants' attitude about the inevitable losses of aging matters, too.\u003c/p>\n\u003cp>\"Some of them thought that aging sucks — your friends die, you get disease, you can't do whatever you want, you can't eat and drink what you like,\" Ferrucci says. \"But others thought aging was not so bad.\" And people who had a positive view of aging at age 40 had significantly less cardiovascular disease later on.\u003c/p>\n\u003cfigure id=\"attachment_174702\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-174702\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-400x300.jpg\" alt=\"At 95, the author's father, Jim Shute, is still wielding a mean pole saw.\" width=\"400\" height=\"300\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-960x720.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">At 95, the author's father, Jim Shute, is still wielding a mean pole saw. \u003ccite>(Nancy Shute/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"How that works will require a lot more work from us,\" Ferrucci says. \"But clearly these people have found ways of behaving and thinking and interacting with the environment and other people that works for them.\"\u003c/p>\n\u003cp>I have no idea what my dad's fasting glucose level is, but I've got to think that still doing his own yardwork and playing duplicate bridge has got to play a role in his good health. That and the fact that when I ask him how he's doing he says \"fantastic,\" even when I know that's a stretch.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>My chat with Ferrucci has made my realize that I shouldn't count on lucky genes to give me a free pass. He envisions a day when the science on aging will have become so good that young men and women would get individualized prescriptions on reducing risk. But for now, I think it's time for me to hit \"publish\" and go out for a walk. That would be fantastic.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secrets+Of+The+Very+Old+And+Healthy+%E2%80%94+Start+When+You%27re+Young&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"What you do in your 20s and 30s and 40s can make it more likely that you'll be mobile and healthy in old age, scientists say. That's true even if your ancestors didn't fare so well.","status":"publish","parent":0,"modified":1461083674,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":730},"headData":{"title":"Secrets of Getting to Your 90s -- in Good Health | KQED","description":"What you do in your 20s and 30s and 40s can make it more likely that you'll be mobile and healthy in old age, scientists say. That's true even if your ancestors didn't fare so well.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Secrets of Getting to Your 90s -- in Good Health","datePublished":"2016-04-19T16:34:34.000Z","dateModified":"2016-04-19T16:34:34.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"174700 http://ww2.kqed.org/stateofhealth/?p=174700","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/19/secrets-of-getting-to-your-90s-in-good-health/","disqusTitle":"Secrets of Getting to Your 90s -- in Good Health","nprImageCredit":"Fanatic Studio","nprByline":"Nancy Shute\u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Collection Mix: Sub/Getty Images","nprStoryId":"474668196","nprApiLink":"http://api.npr.org/query?id=474668196&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/04/18/474668196/secrets-of-the-very-old-and-healthy-start-when-youre-young?ft=nprml&f=474668196","nprRetrievedStory":"1","nprPubDate":"Mon, 18 Apr 2016 16:50:00 -0400","nprStoryDate":"Mon, 18 Apr 2016 14:25:00 -0400","nprLastModifiedDate":"Mon, 18 Apr 2016 16:50:53 -0400","path":"/stateofhealth/174700/secrets-of-getting-to-your-90s-in-good-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to getting old, some of us are a lot better at it than others. If I'm going to live to be 95 I would much prefer to be healthy, cogent and content. So I want to know the secrets of the healthy and very old.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The good news is that there's a lot we can do about it.' \u003ccite>Dr. Luigi Ferrucci, National Institute on Aging \u003c/cite>\u003c/aside>\n\u003cp>Fortunately, scientists are starting to figure that out, \"The good news is that there's a lot we can do about it,\" says \u003ca href=\"http://www.grc.nia.nih.gov/branches/irp/lferrucci.htm\">Dr. Luigi Ferrucci\u003c/a>, a geriatrician and scientific director at the National Institute on Aging. He wants to see more and more people in that state of \"aging grace.\"\u003c/p>\n\u003cp>I've been thinking a lot about what makes for a robust old age because my dad just turned 95. On his birthday, he pruned trees in the yard, took a walk, played a little online solitaire and had dinner with the family. We stayed up late and laughed a lot. Last week he did his taxes — the old-fashioned way, with a pencil, a calculator and a stack of IRS forms.\u003c/p>\n\u003cp>Clearly Dad has genetics in his favor; his father lived to be 97. But genes aren't fate, Ferrucci says: \"There's some destiny; we are children of our genome and what we inherit from our parents. But we can do a lot to avoid the destiny that was predisposed to us.\"\u003c/p>\n\u003cp>Studies have found that genes are a factor in extreme longevity just about 20 percent of the time, but being physically healthy while very old is much more likely to run in families. Clearly those families must be doing something right.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>To find out, in 2009 the NIH launched the \u003ca href=\"https://www.nia.nih.gov/health/publication/healthy-aging-lessons-baltimore-longitudinal-study-aging/blsas-ideal-future\">IDEAL\u003c/a> study, which focuses on the families of people who were able to delay or evade ill health in their 80s and beyond.\u003c/p>\n\u003cp>They've already gotten some physiological clues. Healthy old people are much more likely to have a lower resting metabolic rate, Ferrucci says, which means that their bodies are still working efficiently. \"They have energy left for other activities,\" he says. \"It allows them to do many, many things during daily life.\"\u003c/p>\n\u003cp>The lucky ones also tend to have fasting glucose numbers more typical of people in their 20s. Obesity and lack of exercise increase the risk of insulin resistance, so keeping weight under control and staying active from early adulthood can help there, Ferrucci says. Medications like metformin for people with insulin resistance help, too. \"There's a lot you can do to manage your insulin resistance as soon as you realize it's there.\"\u003c/p>\n\u003cp>Other studies, including the landmark \u003ca href=\"https://www.blsa.nih.gov/\">Baltimore Longitudinal Study on Aging\u003c/a>, have found that participants' attitude about the inevitable losses of aging matters, too.\u003c/p>\n\u003cp>\"Some of them thought that aging sucks — your friends die, you get disease, you can't do whatever you want, you can't eat and drink what you like,\" Ferrucci says. \"But others thought aging was not so bad.\" And people who had a positive view of aging at age 40 had significantly less cardiovascular disease later on.\u003c/p>\n\u003cfigure id=\"attachment_174702\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-174702\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-400x300.jpg\" alt=\"At 95, the author's father, Jim Shute, is still wielding a mean pole saw.\" width=\"400\" height=\"300\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/mr-shute-9743c33d0c26491c0cd77022379b9e18262afd1b-960x720.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">At 95, the author's father, Jim Shute, is still wielding a mean pole saw. \u003ccite>(Nancy Shute/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"How that works will require a lot more work from us,\" Ferrucci says. \"But clearly these people have found ways of behaving and thinking and interacting with the environment and other people that works for them.\"\u003c/p>\n\u003cp>I have no idea what my dad's fasting glucose level is, but I've got to think that still doing his own yardwork and playing duplicate bridge has got to play a role in his good health. That and the fact that when I ask him how he's doing he says \"fantastic,\" even when I know that's a stretch.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>My chat with Ferrucci has made my realize that I shouldn't count on lucky genes to give me a free pass. He envisions a day when the science on aging will have become so good that young men and women would get individualized prescriptions on reducing risk. But for now, I think it's time for me to hit \"publish\" and go out for a walk. That would be fantastic.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secrets+Of+The+Very+Old+And+Healthy+%E2%80%94+Start+When+You%27re+Young&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/174700/secrets-of-getting-to-your-90s-in-good-health","authors":["byline_stateofhealth_174700"],"categories":["stateofhealth_12"],"tags":["stateofhealth_186","stateofhealth_2740","stateofhealth_58","stateofhealth_298"],"featImg":"stateofhealth_174701","label":"stateofhealth"},"stateofhealth_135403":{"type":"posts","id":"stateofhealth_135403","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"135403","score":null,"sort":[1452122490000]},"guestAuthors":[],"slug":"how-a-simple-bump-can-cause-an-insidious-brain-injury","title":"How A Simple Bump Can Cause An Insidious Brain Injury","publishDate":1452122490,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>It's not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don't know it.\u003c/p>\n\u003cp>One such doctor is \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/10000041/Bryan-Arling\" target=\"_blank\">Bryan Arling\u003c/a>, an internist in Washington, D.C. His peers often vote to put him on those lists of \"top doctors,\" published by glossy magazines.\u003c/p>\n\u003cp>So it's ironic that the brain injury he failed to diagnose was his own. And he could have died from it.\u003c/p>\n\u003cp>Last spring, Arling went looking for some files in his walk-up attic. It was jammed with boxes of Christmas tree ornaments, old clothes and other odds and ends that define decades of family life. After an hour of searching, he found the files in a box, grabbed the folders and stood up. He then felt a shooting pain in the center of his back.\u003c/p>\n\u003cp>\"It's a pain I've had before,\" says Arling, who has battled back problems for years. \"But it was more intense than I've ever had it before.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He took painkillers and went back to work. Weeks went by, and his back was still hurting him.\u003c/p>\n\u003cp>\"Then I began noticing that I was shuffling. I was so weak I couldn't carry my plate out to the back deck. I would just drop things. And everybody commented on how I seemed different,\" he says.\u003c/p>\n\u003cp>And gradually, Arling says, his thinking seemed different, too.\u003c/p>\n\u003cp>\"I could make sense of things, I could get things done, I could make decisions,\" he says. \"But I was slower at what I did.\"\u003c/p>\n\u003cp>Arling thought he was having trouble focusing because his back pain was so intense. So a neurosurgeon, who had treated Arling's back problems before, ordered an MRI of Arling's spine — and also his brain. When the MRI technician saw Arling's pictures taking shape on his screen, he called the radiologist and said, \"You need to see this right away.\"\u003c/p>\n\u003cp>The images showed a big, white, lake-like shape where Arling's brain should have been, inside the top right side of his skull. It was a pool of blood that was pushing down on the brain, causing it to shift from right to left.\u003c/p>\n\u003cp>They sent Arling straight from the MRI to the emergency room at Georgetown University Medical Center. He says as they started prepping him for open brain surgery, the medical staff kept asking about his fall.\u003c/p>\n\u003cp>\"And I said, 'I haven't fallen,' \" Arling says.\u003c/p>\n\u003cp>Then, just as they were wheeling him into the operating room, Arling remembered: The day he stood up in the attic and threw out his back, he had forgotten he was under the eaves, and had knocked the top of his head against a wood beam. But he didn't even get a cut, so he forgot about it.\u003c/p>\n\u003cp>Everybody knows you can get hurt if you fall off a ladder, or slip and bash your head on the ice. But Arling got a kind of brain injury that's usually more insidious — a \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000713.htm\" target=\"_blank\">subdural hematoma\u003c/a>.\u003c/p>\n\u003cp>A subdural hematoma is different from the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=129726135\" target=\"_blank\">typical blast injuries\u003c/a> that affected hundreds of thousands of U.S. troops in Iraq and Afghanistan. In those cases, shock waves rattled their brains and caused microscopic damage that's hard or impossible to detect. It's also different from the usual football concussions, in which blows to the head damage the brain's electrical wiring.\u003c/p>\n\u003cp>The main population at risk for a subdural hematoma is the elderly. To understand why, it helps to picture an aging brain. The brain is wrapped and protected by a membrane called the dura mater. Inside the dura, there's a network of veins that connect it to the surface of the brain.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-135431 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png\" alt=\"Screen Shot 2016-01-06 at 3.19.26 PM\" width=\"400\" height=\"324\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM.png 423w\" sizes=\"(max-width: 400px) 100vw, 400px\">Studies suggest that as you get older, your brain shrinks and pulls away from the dura, especially after you're 60 or 70 years old. But the veins keep holding on to both the dura and the brain. So as your brain pulls away, some of those veins become more exposed and more vulnerable.\u003c/p>\n\u003cp>Researchers say if you simply bump your head on the eaves of your attic, as Arling did, or if you simply start to fall and then catch yourself — so your head doesn't strike anything, but it jerks in the air — that can be enough force to jostle your shrinking brain.\u003c/p>\n\u003cp>\"And those veins stretch, and you'll get tearing in those veins,\" says \u003ca href=\"http://www.pmr.vcu.edu/Department/Directory/faculty/dcifu/dcifu.aspx\" target=\"_blank\">Dr. David Cifu\u003c/a>, who runs a joint research project studying brain injuries for the departments of Defense and Veterans Affairs.\u003c/p>\n\u003cp>And because blood from veins tends to ooze, instead of pump as it does from arteries, Cifu says, \"when the veins tear, we get a very low-pressure ribbon of blood that's layering on top of the surface of the brain.\"\u003c/p>\n\u003cp>As that blood starts to pool over days or weeks, it irritates the brain cells. And if the pool's big enough, it presses on the brain and damages it, much like a tumor.\u003c/p>\n\u003cp>Researchers studied the problem a few years ago at a sample of 20 percent of the nation's hospitals. As they \u003ca href=\"http://www.npr.org/documents/2016/jan/rates-of-traumatic-subdural-hematoma.pdf\" target=\"_blank\">reported in the Journal of Neurosurgery\u003c/a>, those hospitals alone diagnosed almost 44,000 subdural hematomas in one year. So the researchers estimate there could be more than 200,000 subdural hematoma injuries diagnosed annually at all the hospitals across the country.\u003c/p>\n\u003cp>They say an unknown additional number of subdural hematomas are misdiagnosed, or simply missed: Half the patients studied have trouble remembering they hit their heads at all.\u003c/p>\n\u003cp>Like Arling. And like Tom Feild, a retired computer systems analyst who used to work for the VA.\u003c/p>\n\u003cfigure id=\"attachment_135405\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-135405\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/tbi-at-home1-2bfc90dd1b879b954a1f0aa6ac297c5c1a7d10da-e1452122149567.jpg\" alt=\"Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving. \u003ccite>(Matailong Du for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Feild says his own medical mystery began with headaches.\u003c/p>\n\u003cp>\"It wasn't a constant headache — it was a low-grade headache. But it wouldn't go away,\" he says.\u003c/p>\n\u003cp>Then he was driving his wife on an errand, and he kept drifting across the yellow line.\u003c/p>\n\u003cp>\"I said, 'Tom, you're going on their side of the road.' He said, 'I know ... I can't seem to help it,' \" Jody Feild says.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Tom Feild made an appointment with his local doctor. And the next thing he knew, a helicopter was rushing him to Virginia Commonwealth University Medical Center in Richmond. Neurosurgeon Bill Broaddus drilled three holes into Feild's skull and vacuumed out roughly 8 ounces of blood that had pooled since he developed a subdural hematoma.\u003cstrong>\u003cem>\u003cbr>\n\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Broaddus says before the surgery, he asked Feild what type of accident had injured his head. It took awhile before Feild could remember. He had put a sprinkler away under his porch two months earlier and bumped his head against the floorboards when he stood up before backing out all the way.\u003c/p>\n\u003cp>\"We may see 50 to 100 [similar subdural hematomas] here at this institution every year,\" says Broaddus.\u003c/p>\n\u003cp>Brain specialists say it's important to view these injuries in perspective: Most people who get a subdural hematoma will never know it. The brain will reabsorb the blood, the victim's symptoms will disappear, and life will go on as normal. But for tens of thousands of others, it's serious. Doctors say they often see families who think loved ones are getting dementia, and it turns out they hit their heads and have a bleed. Some victims die.\u003c/p>\n\u003cp>Researchers like Cifu say you don't need to consult a doctor the second you get a headache. But they say it's sensible, and responsible, to follow some simple guidelines: Consult a physician as soon as possible if the headaches don't go away, or if you begin to have trouble with your balance or feel weakness in your legs or arms. Also, if the way you think starts to seem \"different,\" Cifu says.\u003c/p>\n\u003cp>Internist Arling says even if it turns out that you do have a bleed, he's living proof that these brain injuries can be cured if you catch them in time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It's so easy to come away from a story like mine, and to feel fragile, and so to worry unnecessarily,\" Arling says. \"The body is phenomenally well-designed, and it has a phenomenal ability to heal itself.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+A+Simple+Bump+Can+Cause+An+Insidious+Brain+Injury&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Hundreds of thousands of people suffer brain injuries each year. Sometimes the damage is caused by something that seems innocuous, like a stumble or a bump on the head. When should you see a doctor?","status":"publish","parent":0,"modified":1452122490,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1450},"headData":{"title":"How A Simple Bump Can Cause An Insidious Brain Injury | KQED","description":"Hundreds of thousands of people suffer brain injuries each year. Sometimes the damage is caused by something that seems innocuous, like a stumble or a bump on the head. When should you see a doctor?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How A Simple Bump Can Cause An Insidious Brain Injury","datePublished":"2016-01-06T23:21:30.000Z","dateModified":"2016-01-06T23:21:30.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"135403 http://ww2.kqed.org/stateofhealth/?p=135403","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/01/06/how-a-simple-bump-can-cause-an-insidious-brain-injury/","disqusTitle":"How A Simple Bump Can Cause An Insidious Brain Injury","source":"NPR","sourceUrl":"http://www.npr.org/sections/health-shots/2016/01/06/462138708/how-a-simple-bump-can-cause-an-insidious-brain-injury","nprByline":"Daniel Zwerdling","nprImageAgency":"Courtesy of Dr. Ingrid Ott, Washington Radiology Associates","nprStoryId":"462138708","nprApiLink":"http://api.npr.org/query?id=462138708&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/01/06/462138708/how-a-simple-bump-can-cause-an-insidious-brain-injury?ft=nprml&f=462138708","nprRetrievedStory":"1","nprPubDate":"Wed, 06 Jan 2016 13:20:00 -0500","nprStoryDate":"Wed, 06 Jan 2016 12:46:00 -0500","nprLastModifiedDate":"Wed, 06 Jan 2016 13:20:42 -0500","path":"/stateofhealth/135403/how-a-simple-bump-can-cause-an-insidious-brain-injury","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don't know it.\u003c/p>\n\u003cp>One such doctor is \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/10000041/Bryan-Arling\" target=\"_blank\">Bryan Arling\u003c/a>, an internist in Washington, D.C. His peers often vote to put him on those lists of \"top doctors,\" published by glossy magazines.\u003c/p>\n\u003cp>So it's ironic that the brain injury he failed to diagnose was his own. And he could have died from it.\u003c/p>\n\u003cp>Last spring, Arling went looking for some files in his walk-up attic. It was jammed with boxes of Christmas tree ornaments, old clothes and other odds and ends that define decades of family life. After an hour of searching, he found the files in a box, grabbed the folders and stood up. He then felt a shooting pain in the center of his back.\u003c/p>\n\u003cp>\"It's a pain I've had before,\" says Arling, who has battled back problems for years. \"But it was more intense than I've ever had it before.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He took painkillers and went back to work. Weeks went by, and his back was still hurting him.\u003c/p>\n\u003cp>\"Then I began noticing that I was shuffling. I was so weak I couldn't carry my plate out to the back deck. I would just drop things. And everybody commented on how I seemed different,\" he says.\u003c/p>\n\u003cp>And gradually, Arling says, his thinking seemed different, too.\u003c/p>\n\u003cp>\"I could make sense of things, I could get things done, I could make decisions,\" he says. \"But I was slower at what I did.\"\u003c/p>\n\u003cp>Arling thought he was having trouble focusing because his back pain was so intense. So a neurosurgeon, who had treated Arling's back problems before, ordered an MRI of Arling's spine — and also his brain. When the MRI technician saw Arling's pictures taking shape on his screen, he called the radiologist and said, \"You need to see this right away.\"\u003c/p>\n\u003cp>The images showed a big, white, lake-like shape where Arling's brain should have been, inside the top right side of his skull. It was a pool of blood that was pushing down on the brain, causing it to shift from right to left.\u003c/p>\n\u003cp>They sent Arling straight from the MRI to the emergency room at Georgetown University Medical Center. He says as they started prepping him for open brain surgery, the medical staff kept asking about his fall.\u003c/p>\n\u003cp>\"And I said, 'I haven't fallen,' \" Arling says.\u003c/p>\n\u003cp>Then, just as they were wheeling him into the operating room, Arling remembered: The day he stood up in the attic and threw out his back, he had forgotten he was under the eaves, and had knocked the top of his head against a wood beam. But he didn't even get a cut, so he forgot about it.\u003c/p>\n\u003cp>Everybody knows you can get hurt if you fall off a ladder, or slip and bash your head on the ice. But Arling got a kind of brain injury that's usually more insidious — a \u003ca href=\"https://www.nlm.nih.gov/medlineplus/ency/article/000713.htm\" target=\"_blank\">subdural hematoma\u003c/a>.\u003c/p>\n\u003cp>A subdural hematoma is different from the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=129726135\" target=\"_blank\">typical blast injuries\u003c/a> that affected hundreds of thousands of U.S. troops in Iraq and Afghanistan. In those cases, shock waves rattled their brains and caused microscopic damage that's hard or impossible to detect. It's also different from the usual football concussions, in which blows to the head damage the brain's electrical wiring.\u003c/p>\n\u003cp>The main population at risk for a subdural hematoma is the elderly. To understand why, it helps to picture an aging brain. The brain is wrapped and protected by a membrane called the dura mater. Inside the dura, there's a network of veins that connect it to the surface of the brain.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-135431 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png\" alt=\"Screen Shot 2016-01-06 at 3.19.26 PM\" width=\"400\" height=\"324\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM-400x324.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/Screen-Shot-2016-01-06-at-3.19.26-PM.png 423w\" sizes=\"(max-width: 400px) 100vw, 400px\">Studies suggest that as you get older, your brain shrinks and pulls away from the dura, especially after you're 60 or 70 years old. But the veins keep holding on to both the dura and the brain. So as your brain pulls away, some of those veins become more exposed and more vulnerable.\u003c/p>\n\u003cp>Researchers say if you simply bump your head on the eaves of your attic, as Arling did, or if you simply start to fall and then catch yourself — so your head doesn't strike anything, but it jerks in the air — that can be enough force to jostle your shrinking brain.\u003c/p>\n\u003cp>\"And those veins stretch, and you'll get tearing in those veins,\" says \u003ca href=\"http://www.pmr.vcu.edu/Department/Directory/faculty/dcifu/dcifu.aspx\" target=\"_blank\">Dr. David Cifu\u003c/a>, who runs a joint research project studying brain injuries for the departments of Defense and Veterans Affairs.\u003c/p>\n\u003cp>And because blood from veins tends to ooze, instead of pump as it does from arteries, Cifu says, \"when the veins tear, we get a very low-pressure ribbon of blood that's layering on top of the surface of the brain.\"\u003c/p>\n\u003cp>As that blood starts to pool over days or weeks, it irritates the brain cells. And if the pool's big enough, it presses on the brain and damages it, much like a tumor.\u003c/p>\n\u003cp>Researchers studied the problem a few years ago at a sample of 20 percent of the nation's hospitals. As they \u003ca href=\"http://www.npr.org/documents/2016/jan/rates-of-traumatic-subdural-hematoma.pdf\" target=\"_blank\">reported in the Journal of Neurosurgery\u003c/a>, those hospitals alone diagnosed almost 44,000 subdural hematomas in one year. So the researchers estimate there could be more than 200,000 subdural hematoma injuries diagnosed annually at all the hospitals across the country.\u003c/p>\n\u003cp>They say an unknown additional number of subdural hematomas are misdiagnosed, or simply missed: Half the patients studied have trouble remembering they hit their heads at all.\u003c/p>\n\u003cp>Like Arling. And like Tom Feild, a retired computer systems analyst who used to work for the VA.\u003c/p>\n\u003cfigure id=\"attachment_135405\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-135405\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/tbi-at-home1-2bfc90dd1b879b954a1f0aa6ac297c5c1a7d10da-e1452122149567.jpg\" alt=\"Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn't go away and difficulty driving. \u003ccite>(Matailong Du for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Feild says his own medical mystery began with headaches.\u003c/p>\n\u003cp>\"It wasn't a constant headache — it was a low-grade headache. But it wouldn't go away,\" he says.\u003c/p>\n\u003cp>Then he was driving his wife on an errand, and he kept drifting across the yellow line.\u003c/p>\n\u003cp>\"I said, 'Tom, you're going on their side of the road.' He said, 'I know ... I can't seem to help it,' \" Jody Feild says.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Tom Feild made an appointment with his local doctor. And the next thing he knew, a helicopter was rushing him to Virginia Commonwealth University Medical Center in Richmond. Neurosurgeon Bill Broaddus drilled three holes into Feild's skull and vacuumed out roughly 8 ounces of blood that had pooled since he developed a subdural hematoma.\u003cstrong>\u003cem>\u003cbr>\n\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Broaddus says before the surgery, he asked Feild what type of accident had injured his head. It took awhile before Feild could remember. He had put a sprinkler away under his porch two months earlier and bumped his head against the floorboards when he stood up before backing out all the way.\u003c/p>\n\u003cp>\"We may see 50 to 100 [similar subdural hematomas] here at this institution every year,\" says Broaddus.\u003c/p>\n\u003cp>Brain specialists say it's important to view these injuries in perspective: Most people who get a subdural hematoma will never know it. The brain will reabsorb the blood, the victim's symptoms will disappear, and life will go on as normal. But for tens of thousands of others, it's serious. Doctors say they often see families who think loved ones are getting dementia, and it turns out they hit their heads and have a bleed. Some victims die.\u003c/p>\n\u003cp>Researchers like Cifu say you don't need to consult a doctor the second you get a headache. But they say it's sensible, and responsible, to follow some simple guidelines: Consult a physician as soon as possible if the headaches don't go away, or if you begin to have trouble with your balance or feel weakness in your legs or arms. Also, if the way you think starts to seem \"different,\" Cifu says.\u003c/p>\n\u003cp>Internist Arling says even if it turns out that you do have a bleed, he's living proof that these brain injuries can be cured if you catch them in time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's so easy to come away from a story like mine, and to feel fragile, and so to worry unnecessarily,\" Arling says. \"The body is phenomenally well-designed, and it has a phenomenal ability to heal itself.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+A+Simple+Bump+Can+Cause+An+Insidious+Brain+Injury&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/135403/how-a-simple-bump-can-cause-an-insidious-brain-injury","authors":["byline_stateofhealth_135403"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_186","stateofhealth_461"],"featImg":"stateofhealth_135404","label":"source_stateofhealth_135403"},"stateofhealth_81630":{"type":"posts","id":"stateofhealth_81630","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"81630","score":null,"sort":[1443802513000]},"guestAuthors":[],"slug":"senior-villages-movement-confronts-growing-pains","title":"'Senior Villages' Struggle with Call to Diversify","publishDate":1443802513,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>You couldn’t pay any of the 80-year-olds in this Pacific Heights living room to go to a senior center. About a dozen sit in a circle in armchairs, or shoulder to shoulder on the sofa, a thick book of plays in their laps.\u003c/p>\n\u003cp>\"One, two, cha cha cha!\" one woman reads, \"Very good, cha cha cha!\"\u003c/p>\n\u003cp>The group gathers once a month, rotating among each other's houses, to read plays together. Today, it’s Neil Simon’s “Come Blow Your Horn,” a comedy about a young man, bored living with his parents, who moves in with his older brother to find excitement.\u003c/p>\n\u003cp>\"Answer phone, cha cha cha,\" the actor reads. \"Hello? Snow? Don’t you know you could get arrested for having such a sexy voice?\"\u003c/p>\n\u003cp>Everyone here is a member of the \u003ca href=\"http://www.sfvillage.org\" target=\"_blank\">San Francisco Village\u003c/a> -- a grass-roots group of local seniors from across the city, who banded together to support each other so they could stay home as they age.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/226663948\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Members help each other with things like grocery shopping, changing lightbulbs, giving rides to doctors’ appointments. A corps of volunteers is on hand to help with gardening, computer support and other chores. And a roster of local vendors offers a range of discounted services, like plumbing. But at the heart of the movement are the social activities.\u003c/p>\n\u003cp>\"You know what I hear they played at 3 in the morning?\" another actor reads from the script. \"Strip Scrabble.\"\u003c/p>\n\u003cp>Throughout the year, there are holiday dinners, museum outings, yoga classes, hiking groups. Sarah Goldman started this play-reading group five years ago. For her, joining the village was really about meeting new people after she left her job.\u003c/p>\n\u003cp>\"So the village came along at a time when I was looking to expand a friendship circle,\" she says.\u003c/p>\n\u003cp>It’s more than that, of course. Goldman is 87. The stairs in her apartment building seem to be getting steeper every year. She knows she can't stay forever.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>I do not want to move to a continuing care community,\" she says. \"Nor would I have the funds to do so if I did.\"\u003c/p>\n\u003cp>Like many elderly people, Goldman isn't interested in living with her kids.\u003c/p>\n\u003cp>\"My family is estranged from me, my biological family,\" she says. \"I have difficult relationships. They’re across the country.\"\u003c/p>\n\u003cp>Goldman had hoped people in the village could help her identify somewhere else to live on her own. But in mid-September, she moved into a retirement community in San Francisco, one that can provide assisted living if she ever needs it. She says she's still part of the village and plans to continue with the play-reading group and other activities.\u003c/p>\n\u003cp>\"I appreciate being able to have people that I can talk to,\" she says.\u003c/p>\n\u003cp>\u003cstrong>100 Villages and Growing\u003c/strong>\u003c/p>\n\u003cp>There are now more than 100 senior villages across the country, and another hundred in the works. But as the movement grows, it is starting to confront some growing pains, particularly around financial sustainability and diversity.\u003c/p>\n\u003cp>Ninety percent of village members are white and middle class. These demographics date back to the founders of the village movement: They didn't have the money to pay for full-time care to stay at home, but they had too much money to qualify for many government services. Most in-home programs are strictly for low-income folks.\u003c/p>\n\u003cp>\"But there aren’t really services for seniors who are near poor, or who are middle income,\" says Carrie Graham, a medical sociologist at UC Berkeley who studies villages.\u003cem> \"\u003c/em>And a lot of services that are available to middle-income seniors are unaffordable.\"\u003c/p>\n\u003cp>Joining a village costs about $50 a month. Those membership fees fund the staff that administers the services and organizes volunteers who give rides and help with chores. But those fees may not be enough anymore. As members grow older, Graham says, village finances are getting strained.\u003c/p>\n\u003cp>\"We hear villages saying older members might use more services, they might need more volunteers,\" she says.\u003c/p>\n\u003cp>\u003cstrong>New Funds Come with Strings Attached\u003c/strong>\u003c/p>\n\u003cp>So they’re looking for more money. In San Francisco, the village started hunting for grants from the city and foundations. But this money comes with strings attached. Funders want the white, middle-class movement to expand to more low-income and minority elders. This might be harder than it sounds.\u003c/p>\n\u003cp>At a recent happy hour for members of the Ashby Village in Berkeley, everyone was white. Executive Director Andy Gaines says the Berkeley group was started by former professors from the university. Diversifying beyond that circle has been really difficult.\u003c/p>\n\u003cp>News about Ashby Village \"is very much passing word of mouth,\" Gaines says. \"So it’s people who know people, and so the tendency is for it to stay within a smaller community.\"\u003c/p>\n\u003cp>Ashby Village tried to recruit more African-Americans from local churches. But they weren’t interested. Some organizers have observed that communities of color have a stronger emphasis on families caring for elders.\u003c/p>\n\u003cp>\"There tends to be a stereotype of ethnic groups or immigrant groups being much more accepting of relying on their children. And in fact, expect to rely on their children in old age,\" says Graham. \"It would make sense that they may not find a model of independent aging as attractive.\"\u003c/p>\n\u003cp>In general, Graham and Gaines have noticed a tendency toward racial and religious isolation in aging services.\u003c/p>\n\u003cfigure id=\"attachment_83261\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg\">\u003cimg class=\"size-thumbnail wp-image-83261\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg\" alt=\"Janey Norman is a member of San Francisco Village. \" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg 959w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Janey Norman is a member of San Francisco Village. \u003ccite>(Courtesy: San Francisco Village)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"Especially as people are growing older, there is more kind of desire to stay like with like,\" Gaines says. \"And less active movement towards reaching out to meet other populations.\"\u003c/p>\n\u003cp>Back at San Francisco Village, member Janey Norman thinks the focus on race is misplaced. She’s African-American. She says, for her, joining the village was never about meeting other people of color.\u003c/p>\n\u003cp>\"Belonging to a village, it’s about human beings and\u003cem> \u003c/em>sharing interests, and caring for each other and being there for each other,\" she says.\u003c/p>\n\u003cp>Norman is all for subsidizing membership fees so that low-income people can join the village. But the idea of funders pushing the movement to diversify racially offends her.\u003c/p>\n\u003cp>\"It becomes a money thing. 'If we get more black people in here, if we get more Asians, we can get more money here,' \" she says. \"What is all of this? Why? Why?\"\u003c/p>\n\u003cp>What Norman wants is friends to share a bottle of Louis Martini cabernet with. People to talk to about art and music. Folks who will look out for her if there’s an earthquake.\u003c/p>\n\u003cp>\"It goes beyond color, OK,\" she says. \"To me it’s not about color. It’s about connection with human beings.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>New America Media and the Gerontological Society of America provided support for this story. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Groups of seniors create these associations to share both errands and social activities, so they can continue living at home. ","status":"publish","parent":0,"modified":1443830758,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":39,"wordCount":1207},"headData":{"title":"'Senior Villages' Struggle with Call to Diversify | KQED","description":"Groups of seniors create these associations to share both errands and social activities, so they can continue living at home. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"'Senior Villages' Struggle with Call to Diversify","datePublished":"2015-10-02T16:15:13.000Z","dateModified":"2015-10-03T00:05:58.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"81630 http://ww2.kqed.org/stateofhealth/?p=81630","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/02/senior-villages-movement-confronts-growing-pains/","disqusTitle":"'Senior Villages' Struggle with Call to Diversify","path":"/stateofhealth/81630/senior-villages-movement-confronts-growing-pains","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>You couldn’t pay any of the 80-year-olds in this Pacific Heights living room to go to a senior center. About a dozen sit in a circle in armchairs, or shoulder to shoulder on the sofa, a thick book of plays in their laps.\u003c/p>\n\u003cp>\"One, two, cha cha cha!\" one woman reads, \"Very good, cha cha cha!\"\u003c/p>\n\u003cp>The group gathers once a month, rotating among each other's houses, to read plays together. Today, it’s Neil Simon’s “Come Blow Your Horn,” a comedy about a young man, bored living with his parents, who moves in with his older brother to find excitement.\u003c/p>\n\u003cp>\"Answer phone, cha cha cha,\" the actor reads. \"Hello? Snow? Don’t you know you could get arrested for having such a sexy voice?\"\u003c/p>\n\u003cp>Everyone here is a member of the \u003ca href=\"http://www.sfvillage.org\" target=\"_blank\">San Francisco Village\u003c/a> -- a grass-roots group of local seniors from across the city, who banded together to support each other so they could stay home as they age.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/226663948&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/226663948'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Members help each other with things like grocery shopping, changing lightbulbs, giving rides to doctors’ appointments. A corps of volunteers is on hand to help with gardening, computer support and other chores. And a roster of local vendors offers a range of discounted services, like plumbing. But at the heart of the movement are the social activities.\u003c/p>\n\u003cp>\"You know what I hear they played at 3 in the morning?\" another actor reads from the script. \"Strip Scrabble.\"\u003c/p>\n\u003cp>Throughout the year, there are holiday dinners, museum outings, yoga classes, hiking groups. Sarah Goldman started this play-reading group five years ago. For her, joining the village was really about meeting new people after she left her job.\u003c/p>\n\u003cp>\"So the village came along at a time when I was looking to expand a friendship circle,\" she says.\u003c/p>\n\u003cp>It’s more than that, of course. Goldman is 87. The stairs in her apartment building seem to be getting steeper every year. She knows she can't stay forever.\u003c/p>\n\u003cp>\u003ci>\"\u003c/i>I do not want to move to a continuing care community,\" she says. \"Nor would I have the funds to do so if I did.\"\u003c/p>\n\u003cp>Like many elderly people, Goldman isn't interested in living with her kids.\u003c/p>\n\u003cp>\"My family is estranged from me, my biological family,\" she says. \"I have difficult relationships. They’re across the country.\"\u003c/p>\n\u003cp>Goldman had hoped people in the village could help her identify somewhere else to live on her own. But in mid-September, she moved into a retirement community in San Francisco, one that can provide assisted living if she ever needs it. She says she's still part of the village and plans to continue with the play-reading group and other activities.\u003c/p>\n\u003cp>\"I appreciate being able to have people that I can talk to,\" she says.\u003c/p>\n\u003cp>\u003cstrong>100 Villages and Growing\u003c/strong>\u003c/p>\n\u003cp>There are now more than 100 senior villages across the country, and another hundred in the works. But as the movement grows, it is starting to confront some growing pains, particularly around financial sustainability and diversity.\u003c/p>\n\u003cp>Ninety percent of village members are white and middle class. These demographics date back to the founders of the village movement: They didn't have the money to pay for full-time care to stay at home, but they had too much money to qualify for many government services. Most in-home programs are strictly for low-income folks.\u003c/p>\n\u003cp>\"But there aren’t really services for seniors who are near poor, or who are middle income,\" says Carrie Graham, a medical sociologist at UC Berkeley who studies villages.\u003cem> \"\u003c/em>And a lot of services that are available to middle-income seniors are unaffordable.\"\u003c/p>\n\u003cp>Joining a village costs about $50 a month. Those membership fees fund the staff that administers the services and organizes volunteers who give rides and help with chores. But those fees may not be enough anymore. As members grow older, Graham says, village finances are getting strained.\u003c/p>\n\u003cp>\"We hear villages saying older members might use more services, they might need more volunteers,\" she says.\u003c/p>\n\u003cp>\u003cstrong>New Funds Come with Strings Attached\u003c/strong>\u003c/p>\n\u003cp>So they’re looking for more money. In San Francisco, the village started hunting for grants from the city and foundations. But this money comes with strings attached. Funders want the white, middle-class movement to expand to more low-income and minority elders. This might be harder than it sounds.\u003c/p>\n\u003cp>At a recent happy hour for members of the Ashby Village in Berkeley, everyone was white. Executive Director Andy Gaines says the Berkeley group was started by former professors from the university. Diversifying beyond that circle has been really difficult.\u003c/p>\n\u003cp>News about Ashby Village \"is very much passing word of mouth,\" Gaines says. \"So it’s people who know people, and so the tendency is for it to stay within a smaller community.\"\u003c/p>\n\u003cp>Ashby Village tried to recruit more African-Americans from local churches. But they weren’t interested. Some organizers have observed that communities of color have a stronger emphasis on families caring for elders.\u003c/p>\n\u003cp>\"There tends to be a stereotype of ethnic groups or immigrant groups being much more accepting of relying on their children. And in fact, expect to rely on their children in old age,\" says Graham. \"It would make sense that they may not find a model of independent aging as attractive.\"\u003c/p>\n\u003cp>In general, Graham and Gaines have noticed a tendency toward racial and religious isolation in aging services.\u003c/p>\n\u003cfigure id=\"attachment_83261\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg\">\u003cimg class=\"size-thumbnail wp-image-83261\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg\" alt=\"Janey Norman is a member of San Francisco Village. \" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/SFV_Member_JaneyN.jpg 959w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Janey Norman is a member of San Francisco Village. \u003ccite>(Courtesy: San Francisco Village)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"Especially as people are growing older, there is more kind of desire to stay like with like,\" Gaines says. \"And less active movement towards reaching out to meet other populations.\"\u003c/p>\n\u003cp>Back at San Francisco Village, member Janey Norman thinks the focus on race is misplaced. She’s African-American. She says, for her, joining the village was never about meeting other people of color.\u003c/p>\n\u003cp>\"Belonging to a village, it’s about human beings and\u003cem> \u003c/em>sharing interests, and caring for each other and being there for each other,\" she says.\u003c/p>\n\u003cp>Norman is all for subsidizing membership fees so that low-income people can join the village. But the idea of funders pushing the movement to diversify racially offends her.\u003c/p>\n\u003cp>\"It becomes a money thing. 'If we get more black people in here, if we get more Asians, we can get more money here,' \" she says. \"What is all of this? Why? Why?\"\u003c/p>\n\u003cp>What Norman wants is friends to share a bottle of Louis Martini cabernet with. People to talk to about art and music. Folks who will look out for her if there’s an earthquake.\u003c/p>\n\u003cp>\"It goes beyond color, OK,\" she says. \"To me it’s not about color. It’s about connection with human beings.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>New America Media and the Gerontological Society of America provided support for this story. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/81630/senior-villages-movement-confronts-growing-pains","authors":["3205"],"categories":["stateofhealth_11"],"tags":["stateofhealth_186","stateofhealth_2519","stateofhealth_591"],"featImg":"stateofhealth_82684","label":"stateofhealth"},"stateofhealth_22411":{"type":"posts","id":"stateofhealth_22411","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22411","score":null,"sort":[1415386227000]},"guestAuthors":[],"slug":"village-movement-for-aging-seniors-faces-some-challenges","title":"'Village' Movement for Aging Seniors Faces Some Challenges","publishDate":1415386227,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_16541\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS1562_Aging_Healthy_Patrick_Flickr_02212012-e1386288838603.jpg\">\u003cimg class=\"size-large wp-image-16541\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS1562_Aging_Healthy_Patrick_Flickr_02212012-640x512.jpg\" alt=\"(Patrick/Flickr)\" width=\"640\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>“It takes a village” is a common refrain.\u003c/p>\n\u003cp>Now \"Villages\" -- yes, with a capital V -- are sweeping the U.S., looking to redefine how people age in their communities.\u003c/p>\n\u003cp>The Village movement brings together older adults who want to age in their homes independently, but believe it will be too hard to do so, unless they have some support. These virtual villages link independent living seniors together. Members offer support to each other as they are able, and ask for support when they need it through an organized system.\u003c/p>\n\u003cp>Half of all villages in the U.S. started in the last three years. Because they are such a recent phenomenon, there have not been many studies about their outcomes.\u003c!--more-->\u003c/p>\n\u003cp>Now, the initial results from a retrospective,\u003ca title=\"http://heb.sagepub.com/search/results?fulltext=+SCHARLACH&x=-905&y=-237&submit=yes&journal_set=spheb&src=selected&andorexactfulltext=and\" href=\"http://heb.sagepub.com/search/results?fulltext=+SCHARLACH&x=-905&y=-237&submit=yes&journal_set=spheb&src=selected&andorexactfulltext=and\" target=\"_blank\"> three year study \u003c/a>from UC Berkeley find support for many of the movement’s positive claims. Butthe data, being presented at the Gerontological Society of America conference, also raises flags about the communities’ diversity and sustainability.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“People, by and large, report that the village has made a substantial difference in their life,” says Andrew Scharlach, a professor at UC Berkeley and the principal investigator of the ongoing study that includes in-person interviews with 300 residents at nine California villages.\u003c/p>\n\u003cp>The study has shown that over time village members’ desire to move out of their home and community decreased.\u003c/p>\n\u003cp>Also, 55 to 80 percent of respondents reported a jump in quality of life. The more involved they were with the village, the higher the impact.\u003c/p>\n\u003cp>But, Sharlach says, there are some caveats.\u003c/p>\n\u003cp>People in the study self-reported big gains in social connections — knowing more people, getting out of the house more, and interacting with people more than they used to.\u003c/p>\n\u003cp>But when the researchers looked at data from the 133 people they followed over the course of 12 months, there was no evidence that the number of interactions or social connections these people had, had actually changed.\u003c/p>\n\u003cp>“If you ask, the first day of the village, ‘How many people do you know? How often do you get out of the house? How many social activities are you participating in?’ and then you come back a year later and ask the exact same questions,” says Sharlach, “there’s not a significant difference.”\u003c/p>\n\u003cp>He says it’s possible one year may be too soon to see significant changes in numbers, or the questions may not be capturing the growth areas for people. Another possibility is that people join the village during transitions in life and their social circle doesn’t grow, it just shifts.\u003c/p>\n\u003cp>Village participants’ health outcomes are another area policy experts are eager for data about. Sharlach’s team is looking at changes over time in incidents of falls, emergency department visits and hospital admissions. But he says that data is still being processed.\u003c/p>\n\u003cp>The weakest points the study found were around diversity and sustainability.\u003c/p>\n\u003cp>Villages are 94 percent white, according to studies. If they are going to be a model to serve a greater aging population, Sharlach says, the challenges that communities have reflecting the whole population need to be addressed.\u003c/p>\n\u003cp>He says those could include some cultural barriers. The village model is aimed at helping individuals age in place, but in some cultures families and other communities are inextricably linked to their elders. That means adapting the model to serve existing communities.\u003c/p>\n\u003cp>Right now, though, given that they are largely white, Sharlach says that raises questions. “invite someone who is African-American, or Latino or Asian Pacific Islander to join a village,” he says. “And they come to a meeting that is based on social connections and these aren’t people who are naturally part of their social connections, are they going to want to join this club?”\u003c/p>\n\u003cp>Another challenge the study found was the sustainability of Villages.\u003c/p>\n\u003cp>Nationally, and also in California, about 50 percent of the budgets are covered by membership dues, but the other 50 percent has to be raised.\u003c/p>\n\u003cp>“Whether that’s through contracts and grants or through the government, [in order to succeed for the long term] that’s the area that really needs to be figured out,” says Sharlach.\u003c/p>\n\u003cp>The city of San Francisco stands out as a government that has supported its two villages. In February 2013 the city gave $50,000 each to the San Francisco Village and the NEXT Village. But these grants are the exception, not the rule.\u003c/p>\n\u003cp>Sharlach says the study shows there are great benefits to be had from the Village model, but the challenges suggest the model really needs to be models, plural, to serve the many communities that could take advantage of them.\u003c/p>\n\u003cp>The UC Berkeley study followed residents at nine communities in California. Most were suburban but it included the rural Community Connections program in Plumas County and the urban San Francisco Village were also included. The remaining study sites were Ashby Village (Berkeley), Avenidas (Palo Alto), Santa Barbara Village, Wise Connections (Santa Monica), Westchester Playa Village, Real Connections (Claremont-Pomona), and Tierra Santa in San Diego.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachel Dornhelm wrote this story through a Fellowship from New America Media and the Gerontological Society of America, supported by AARP.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1416436713,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":896},"headData":{"title":"'Village' Movement for Aging Seniors Faces Some Challenges | KQED","description":"“It takes a village” is a common refrain. Now "Villages" -- yes, with a capital V -- are sweeping the U.S., looking to redefine how people age in their communities. The Village movement brings together older adults who want to age in their homes independently, but believe it will be too hard to do so,","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"'Village' Movement for Aging Seniors Faces Some Challenges","datePublished":"2014-11-07T18:50:27.000Z","dateModified":"2014-11-19T22:38:33.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"22411 http://blogs.kqed.org/stateofhealth/?p=22411","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/07/village-movement-for-aging-seniors-faces-some-challenges/","disqusTitle":"'Village' Movement for Aging Seniors Faces Some Challenges","path":"/stateofhealth/22411/village-movement-for-aging-seniors-faces-some-challenges","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16541\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS1562_Aging_Healthy_Patrick_Flickr_02212012-e1386288838603.jpg\">\u003cimg class=\"size-large wp-image-16541\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS1562_Aging_Healthy_Patrick_Flickr_02212012-640x512.jpg\" alt=\"(Patrick/Flickr)\" width=\"640\" height=\"512\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>“It takes a village” is a common refrain.\u003c/p>\n\u003cp>Now \"Villages\" -- yes, with a capital V -- are sweeping the U.S., looking to redefine how people age in their communities.\u003c/p>\n\u003cp>The Village movement brings together older adults who want to age in their homes independently, but believe it will be too hard to do so, unless they have some support. These virtual villages link independent living seniors together. Members offer support to each other as they are able, and ask for support when they need it through an organized system.\u003c/p>\n\u003cp>Half of all villages in the U.S. started in the last three years. Because they are such a recent phenomenon, there have not been many studies about their outcomes.\u003c!--more-->\u003c/p>\n\u003cp>Now, the initial results from a retrospective,\u003ca title=\"http://heb.sagepub.com/search/results?fulltext=+SCHARLACH&x=-905&y=-237&submit=yes&journal_set=spheb&src=selected&andorexactfulltext=and\" href=\"http://heb.sagepub.com/search/results?fulltext=+SCHARLACH&x=-905&y=-237&submit=yes&journal_set=spheb&src=selected&andorexactfulltext=and\" target=\"_blank\"> three year study \u003c/a>from UC Berkeley find support for many of the movement’s positive claims. Butthe data, being presented at the Gerontological Society of America conference, also raises flags about the communities’ diversity and sustainability.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“People, by and large, report that the village has made a substantial difference in their life,” says Andrew Scharlach, a professor at UC Berkeley and the principal investigator of the ongoing study that includes in-person interviews with 300 residents at nine California villages.\u003c/p>\n\u003cp>The study has shown that over time village members’ desire to move out of their home and community decreased.\u003c/p>\n\u003cp>Also, 55 to 80 percent of respondents reported a jump in quality of life. The more involved they were with the village, the higher the impact.\u003c/p>\n\u003cp>But, Sharlach says, there are some caveats.\u003c/p>\n\u003cp>People in the study self-reported big gains in social connections — knowing more people, getting out of the house more, and interacting with people more than they used to.\u003c/p>\n\u003cp>But when the researchers looked at data from the 133 people they followed over the course of 12 months, there was no evidence that the number of interactions or social connections these people had, had actually changed.\u003c/p>\n\u003cp>“If you ask, the first day of the village, ‘How many people do you know? How often do you get out of the house? How many social activities are you participating in?’ and then you come back a year later and ask the exact same questions,” says Sharlach, “there’s not a significant difference.”\u003c/p>\n\u003cp>He says it’s possible one year may be too soon to see significant changes in numbers, or the questions may not be capturing the growth areas for people. Another possibility is that people join the village during transitions in life and their social circle doesn’t grow, it just shifts.\u003c/p>\n\u003cp>Village participants’ health outcomes are another area policy experts are eager for data about. Sharlach’s team is looking at changes over time in incidents of falls, emergency department visits and hospital admissions. But he says that data is still being processed.\u003c/p>\n\u003cp>The weakest points the study found were around diversity and sustainability.\u003c/p>\n\u003cp>Villages are 94 percent white, according to studies. If they are going to be a model to serve a greater aging population, Sharlach says, the challenges that communities have reflecting the whole population need to be addressed.\u003c/p>\n\u003cp>He says those could include some cultural barriers. The village model is aimed at helping individuals age in place, but in some cultures families and other communities are inextricably linked to their elders. That means adapting the model to serve existing communities.\u003c/p>\n\u003cp>Right now, though, given that they are largely white, Sharlach says that raises questions. “invite someone who is African-American, or Latino or Asian Pacific Islander to join a village,” he says. “And they come to a meeting that is based on social connections and these aren’t people who are naturally part of their social connections, are they going to want to join this club?”\u003c/p>\n\u003cp>Another challenge the study found was the sustainability of Villages.\u003c/p>\n\u003cp>Nationally, and also in California, about 50 percent of the budgets are covered by membership dues, but the other 50 percent has to be raised.\u003c/p>\n\u003cp>“Whether that’s through contracts and grants or through the government, [in order to succeed for the long term] that’s the area that really needs to be figured out,” says Sharlach.\u003c/p>\n\u003cp>The city of San Francisco stands out as a government that has supported its two villages. In February 2013 the city gave $50,000 each to the San Francisco Village and the NEXT Village. But these grants are the exception, not the rule.\u003c/p>\n\u003cp>Sharlach says the study shows there are great benefits to be had from the Village model, but the challenges suggest the model really needs to be models, plural, to serve the many communities that could take advantage of them.\u003c/p>\n\u003cp>The UC Berkeley study followed residents at nine communities in California. Most were suburban but it included the rural Community Connections program in Plumas County and the urban San Francisco Village were also included. The remaining study sites were Ashby Village (Berkeley), Avenidas (Palo Alto), Santa Barbara Village, Wise Connections (Santa Monica), Westchester Playa Village, Real Connections (Claremont-Pomona), and Tierra Santa in San Diego.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachel Dornhelm wrote this story through a Fellowship from New America Media and the Gerontological Society of America, supported by AARP.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22411/village-movement-for-aging-seniors-faces-some-challenges","authors":["252"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_591"],"featImg":"stateofhealth_16541","label":"stateofhealth"},"stateofhealth_21266":{"type":"posts","id":"stateofhealth_21266","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21266","score":null,"sort":[1409954586000]},"guestAuthors":[],"slug":"two-women-on-a-mission-to-reform-assisted-living-in-california","title":"Two Women on a Mission to Reform Assisted Living in California","publishDate":1409954586,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_21273\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo.jpg\">\u003cimg class=\"size-large wp-image-21273\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo-640x480.jpg\" alt=\"Chris Murphy (L) and Christina Selder (R) of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christina Selder and Chris Murphy of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Many of us dream of starting a revolution. Few of us make it happen. One of the most dramatic stories of the last year belongs to a loose collection of activists, working to reform assisted living oversight in California. Together with lawmakers, these activists launched 17 bills in Sacramento, 12 of which passed, 2 of which have become law, so far.\u003c/p>\n\u003cp>It’s a big story, but let’s break off one piece, involving a couple women in San Diego with a passion for raw data, strong coffee and home-baked muffins.\u003c/p>\n\u003cp>About a decade ago, Chris Murphy’s mom was suffering from Stage 4 ovarian cancer. She couldn't live on her own. Someone suggested Murphy check out an assisted living facility, and so she took a tour.\u003c/p>\n\u003cp>“This is really a cool place,\" Murphy says she thought at the time. \"Maybe my mother would like to live here. I would like to live here. I was sucked in by the chandeliers, and by the garden, and by the apparent appearance of the facility.\"\u003c/p>\n\u003cp>\u003c!--more-->Sitting in her home office today, with a fan going to hold off the summer heat, Murphy declines to go into detail about how, exactly, her mom died. Murphy eventually sued and settled.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But she continued to stew over it.\u003c/p>\n\u003cp>\"I didn’t know that there was a public record that I could review,\" she says. \"I didn’t know that the facility had had a wrongful death lawsuit against it. That was not in the public record, even when I was able to review the public record, after the lawsuit. I figured that because they were licensed that the state had some meaningful oversight of this facility, only to discover that it was haphazard, in my view, at best.\"\u003c/p>\n\u003cp>Murphy was retired from a career in defense contracting, but she decided to go back to school at San Diego State and study gerontology -- the social and psychological aspects of aging. That’s where she met Chrisy Selder. Selder was doing her thesis on the idea that people who don’t need round-the-clock, licensed nursing care would be happier in homier assisted living -- which happens to be significantly less expensive than skilled nursing care. It’s a commonly accepted idea in California, where the number of assisted living facilities has doubled in the last 25 years. But Selder's thesis fell apart after she worked in a few facilities and interned in the local ombudsman’s office. The more research she did, she says, the less she thought that assisted living really was a good alternative to nursing homes.\u003c/p>\n\u003cp>Recognizing a kindred spirit, Selder joined Murphy to launch a non-profit called \u003ca href=\"http://www.rcfereform.org/\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a>, or CARR. (An RCFE is regulator-speak for Residential Care Facilities for the Elderly. Most of us call them \"assisted living facilities.\")\u003c/p>\n\u003cp>\"There were a lot of things that I learned in that process,\" Murphy says, \"that if I had known at the front end, I may have made better placement choices for my mother. And then I decided I had a lot of information that could be leveraged for the consumer.\u003c/p>\n\u003cp>What CARR did was create an online database of facilities and public records to give consumers \"immediate access to a facility's public documents,\" it says\u003ca href=\"http://www.rcfereform.org/About-Us\" target=\"_blank\"> on CARR's website\u003c/a>. Before CARR, this online access did not exist.\u003c/p>\n\u003cp>There are more than 700 facilities on CARR's website today, including about 30,000 public documents \"harvested\" by Murphy, Selder and volunteer student interns from San Diego State's programs in criminal justice, gerontology, social services, and public health.\u003c/p>\n\u003cp>Except for the website administrator, everyone at CARR is a volunteer. It’s going to take them a long time to get the whole state catalogued. So far, they’ve got San Diego and Imperial Counties, parts of Orange County, and several small, rural counties in Northern California. They've also got \u003ca href=\"https://www.calvet.ca.gov/VetHomes/Pages/Residential-Care.aspx\" target=\"_blank\">CalVet\u003c/a> facilities. Given their non-existent public relations department, the database was a bit of a trade secret, until the day a health reporter named Deborah Schoch did a Google search and turned up CARR’s site. Schoch is with the \u003ca href=\"http://centerforhealthreporting.org/\" target=\"_blank\">Center for Health Reporting\u003c/a> at USC, and she spotted the raw material for a series of investigative reports.\u003c/p>\n\u003cp>\"They went in and hand scanned thousands and thousands of documents,\" Schoch says. \"We were able to use those to detect certain homes and then went in and scanned our own records, and found more homes like that. But (CARR) gave us an entry point. I have to tell you, some of these folders are 3 inches thick, and there may be two of them, and they’re very difficult to navigate. You just have to go through it page by page by page. There’s nothing that says right up front 'somebody died here.'\"\u003c/p>\n\u003cp>Schoch joined forces with \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">\u003cem>UT San Diego\u003c/em>\u003c/a> to detail 27 deaths in San Diego County assisted living -- deaths caused by neglect and abuse. The series they published, “\u003ca href=\"http://centerforhealthreporting.org/topics/elderly-care\" target=\"_blank\">Deadly Neglect\u003c/a>,” was one of several media exposes that inspired those 17 bills in Sacramento.\u003c/p>\n\u003cp>You might think it odd CARR collects the same data the state does, but if you want to get at state data, you have to call your local \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG12.htm\" target=\"_blank\">Department of Social Services\u003c/a> office, and wait for staffers to pull the data on the facilities you're interested in. Murphy says people don’t realize how hard it is to research -- until time is tight and the stakes are high.\u003c/p>\n\u003cp>\"You’re going to take off three days worth of work,\" Murphy says. \"You’re going to make a California records act request. The state of California is going to tell you when you can come in and look at that file.\" Meanwhile she says, your dad is leaving the gas on after he cooks. Or the facility he’s living in now has issued a discharge notice with a deadline.\u003c/p>\n\u003cp>That, and the files are edited to remove data considered \"non-public\" by somebody in Sacramento. Schoch, who put in a Public Records Act request for some facility files, discovered some of the records removed included those detailing injuries and deaths.\u003c/p>\n\u003cp>CARR’s database makes all the inspection, complaint, and civil penalty reports it collects available online for a small fee ($25 a month). Murphy says they have about 30 subscribers at any given time, including placement agencies and attorneys, as well as families looking to place their parents.\u003c/p>\n\u003cp>\"We needed a little bit of revenue. And a little bit of revenue is all we’re getting!\" Murphy says and explodes into laughter.\u003c/p>\n\u003cp>Over the years, Murphy and Selder’s jaundiced opinions have only hardened. From their vantage point, elbow deep in documents, the profit motive leads managers to cut corners. Regulations are enforced unevenly. The problems afflict facilities of all sizes, not just the big, corporate ones. Lobbyists in Sacramento will argue small facilities shouldn’t be regulated as tightly as large ones. Selder disagrees. \"There’s no cluster. [Facilities with] 6 beds are having just as much problems as the125 beds.\"\u003c/p>\n\u003cp>Murphy and Selder don’t rate facilities, because, they say, individual needs are so different. They prefer to upload raw data. This year, they did something they've never done before: sponsor a bill. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\">AB 1523\u003c/a>, now signed into law by Gov. Jerry Brown, mandates all assisted living facilities carry liability insurance. While some owners of small facilities protested they won’t be able to afford the coverage, there’s wide agreement consumers have little recourse to address serious concerns given what many describe as light oversight from state regulators.\u003c/p>\n\u003cp>In a statement CARR issued after the governor signed AB 1523 into law, Murphy and Selder wrote that they hope the law encourages insurance companies to “weed out the poor performers” the state hasn’t managed to, and lead to the closure of facilities that are “un-insurable.”\u003c/p>\n\u003cp>The legislation was co-authored by \u003ca href=\"http://asmdc.org/speaker/\" target=\"_blank\">State Assembly Speaker Toni Atkins\u003c/a>, who represents San Diego.\u003c/p>\n\u003cp>\"I was absolutely shocked to learn that facilities didn’t carry liability insurance,\" Atkins says. \"I had a hard time understanding how any business, in this day and time, and particularly a business that deals with frail, elderly people, could not have liability insurance.\"\u003c/p>\n\u003cp>Speaker Atkins says the evidence presented by “the Chrises” helped build a data-driven case in Sacramento for substantive reform. \"Typically, as a legislator, you want to see the data,\" Atkins says. Murphy and Selder, she says, \"Set about compiling that data, and putting it front of people.\"\u003c/p>\n\u003cp>For those who wanted to see substantive reform of assisted living facilities in California, it's not clear yet how many of the original 17 measures will make it into law, how many were de-fanged in 11th hour rewrites. Schoch has drawn up a handy \u003ca href=\"http://centerforhealthreporting.org/article/bill-bill-assisted-living-reform-package\" target=\"_blank\">scorecard\u003c/a>.\u003c/p>\n\u003cp>\"A lot of it had to do with cost,\" Speaker Atkins says about what killed or altered reform bills in the waning days of the legislative session. She offers up \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\">AB 1454\u003c/a> by Assemblymember Ian Calderon (D-Whittier) as an example. It would have mandated annual, unannounced inspections of all licensed community care facilities, including assisted living homes. This would require more staff at the Department of Social Services, and thus, more money in the agency's budget. The Brown Administration did approve a bigger budget for DSS this year, but it's not a given it would be enough to guarantee annual visits. Atkins holds out hope for future budget boosts, though. \"California's making a turnaround as it relates to health and human service issues, but it's taking awhile,\" she said.\u003c/p>\n\u003cp>Murphy worries about how those bills that do make it into law will be interpreted by regulators. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, and then the regulators are going to come up with whatever they come up with.\" She wants to see the California Department of Social Services set up stakeholders meetings across the state, to ask what families and activists want to see happen next.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268203311\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\n","blocks":[],"excerpt":"Two women started what the state would not: online access to unfiltered information about assisted living facilities.","status":"publish","parent":0,"modified":1465490735,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1790},"headData":{"title":"Two Women on a Mission to Reform Assisted Living in California | KQED","description":"Two women started what the state would not: online access to unfiltered information about assisted living facilities.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Two Women on a Mission to Reform Assisted Living in California","datePublished":"2014-09-05T22:03:06.000Z","dateModified":"2016-06-09T16:45:35.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21266 http://blogs.kqed.org/stateofhealth/?p=21266","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/09/05/two-women-on-a-mission-to-reform-assisted-living-in-california/","disqusTitle":"Two Women on a Mission to Reform Assisted Living in California","path":"/stateofhealth/21266/two-women-on-a-mission-to-reform-assisted-living-in-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21273\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo.jpg\">\u003cimg class=\"size-large wp-image-21273\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/RS11418_photo-640x480.jpg\" alt=\"Chris Murphy (L) and Christina Selder (R) of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Christina Selder and Chris Murphy of Consumer Advocates for RCFE Reform in San Diego conduct their crusade from a modest home office. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Many of us dream of starting a revolution. Few of us make it happen. One of the most dramatic stories of the last year belongs to a loose collection of activists, working to reform assisted living oversight in California. Together with lawmakers, these activists launched 17 bills in Sacramento, 12 of which passed, 2 of which have become law, so far.\u003c/p>\n\u003cp>It’s a big story, but let’s break off one piece, involving a couple women in San Diego with a passion for raw data, strong coffee and home-baked muffins.\u003c/p>\n\u003cp>About a decade ago, Chris Murphy’s mom was suffering from Stage 4 ovarian cancer. She couldn't live on her own. Someone suggested Murphy check out an assisted living facility, and so she took a tour.\u003c/p>\n\u003cp>“This is really a cool place,\" Murphy says she thought at the time. \"Maybe my mother would like to live here. I would like to live here. I was sucked in by the chandeliers, and by the garden, and by the apparent appearance of the facility.\"\u003c/p>\n\u003cp>\u003c!--more-->Sitting in her home office today, with a fan going to hold off the summer heat, Murphy declines to go into detail about how, exactly, her mom died. Murphy eventually sued and settled.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But she continued to stew over it.\u003c/p>\n\u003cp>\"I didn’t know that there was a public record that I could review,\" she says. \"I didn’t know that the facility had had a wrongful death lawsuit against it. That was not in the public record, even when I was able to review the public record, after the lawsuit. I figured that because they were licensed that the state had some meaningful oversight of this facility, only to discover that it was haphazard, in my view, at best.\"\u003c/p>\n\u003cp>Murphy was retired from a career in defense contracting, but she decided to go back to school at San Diego State and study gerontology -- the social and psychological aspects of aging. That’s where she met Chrisy Selder. Selder was doing her thesis on the idea that people who don’t need round-the-clock, licensed nursing care would be happier in homier assisted living -- which happens to be significantly less expensive than skilled nursing care. It’s a commonly accepted idea in California, where the number of assisted living facilities has doubled in the last 25 years. But Selder's thesis fell apart after she worked in a few facilities and interned in the local ombudsman’s office. The more research she did, she says, the less she thought that assisted living really was a good alternative to nursing homes.\u003c/p>\n\u003cp>Recognizing a kindred spirit, Selder joined Murphy to launch a non-profit called \u003ca href=\"http://www.rcfereform.org/\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a>, or CARR. (An RCFE is regulator-speak for Residential Care Facilities for the Elderly. Most of us call them \"assisted living facilities.\")\u003c/p>\n\u003cp>\"There were a lot of things that I learned in that process,\" Murphy says, \"that if I had known at the front end, I may have made better placement choices for my mother. And then I decided I had a lot of information that could be leveraged for the consumer.\u003c/p>\n\u003cp>What CARR did was create an online database of facilities and public records to give consumers \"immediate access to a facility's public documents,\" it says\u003ca href=\"http://www.rcfereform.org/About-Us\" target=\"_blank\"> on CARR's website\u003c/a>. Before CARR, this online access did not exist.\u003c/p>\n\u003cp>There are more than 700 facilities on CARR's website today, including about 30,000 public documents \"harvested\" by Murphy, Selder and volunteer student interns from San Diego State's programs in criminal justice, gerontology, social services, and public health.\u003c/p>\n\u003cp>Except for the website administrator, everyone at CARR is a volunteer. It’s going to take them a long time to get the whole state catalogued. So far, they’ve got San Diego and Imperial Counties, parts of Orange County, and several small, rural counties in Northern California. They've also got \u003ca href=\"https://www.calvet.ca.gov/VetHomes/Pages/Residential-Care.aspx\" target=\"_blank\">CalVet\u003c/a> facilities. Given their non-existent public relations department, the database was a bit of a trade secret, until the day a health reporter named Deborah Schoch did a Google search and turned up CARR’s site. Schoch is with the \u003ca href=\"http://centerforhealthreporting.org/\" target=\"_blank\">Center for Health Reporting\u003c/a> at USC, and she spotted the raw material for a series of investigative reports.\u003c/p>\n\u003cp>\"They went in and hand scanned thousands and thousands of documents,\" Schoch says. \"We were able to use those to detect certain homes and then went in and scanned our own records, and found more homes like that. But (CARR) gave us an entry point. I have to tell you, some of these folders are 3 inches thick, and there may be two of them, and they’re very difficult to navigate. You just have to go through it page by page by page. There’s nothing that says right up front 'somebody died here.'\"\u003c/p>\n\u003cp>Schoch joined forces with \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">\u003cem>UT San Diego\u003c/em>\u003c/a> to detail 27 deaths in San Diego County assisted living -- deaths caused by neglect and abuse. The series they published, “\u003ca href=\"http://centerforhealthreporting.org/topics/elderly-care\" target=\"_blank\">Deadly Neglect\u003c/a>,” was one of several media exposes that inspired those 17 bills in Sacramento.\u003c/p>\n\u003cp>You might think it odd CARR collects the same data the state does, but if you want to get at state data, you have to call your local \u003ca href=\"http://www.cdss.ca.gov/cdssweb/PG12.htm\" target=\"_blank\">Department of Social Services\u003c/a> office, and wait for staffers to pull the data on the facilities you're interested in. Murphy says people don’t realize how hard it is to research -- until time is tight and the stakes are high.\u003c/p>\n\u003cp>\"You’re going to take off three days worth of work,\" Murphy says. \"You’re going to make a California records act request. The state of California is going to tell you when you can come in and look at that file.\" Meanwhile she says, your dad is leaving the gas on after he cooks. Or the facility he’s living in now has issued a discharge notice with a deadline.\u003c/p>\n\u003cp>That, and the files are edited to remove data considered \"non-public\" by somebody in Sacramento. Schoch, who put in a Public Records Act request for some facility files, discovered some of the records removed included those detailing injuries and deaths.\u003c/p>\n\u003cp>CARR’s database makes all the inspection, complaint, and civil penalty reports it collects available online for a small fee ($25 a month). Murphy says they have about 30 subscribers at any given time, including placement agencies and attorneys, as well as families looking to place their parents.\u003c/p>\n\u003cp>\"We needed a little bit of revenue. And a little bit of revenue is all we’re getting!\" Murphy says and explodes into laughter.\u003c/p>\n\u003cp>Over the years, Murphy and Selder’s jaundiced opinions have only hardened. From their vantage point, elbow deep in documents, the profit motive leads managers to cut corners. Regulations are enforced unevenly. The problems afflict facilities of all sizes, not just the big, corporate ones. Lobbyists in Sacramento will argue small facilities shouldn’t be regulated as tightly as large ones. Selder disagrees. \"There’s no cluster. [Facilities with] 6 beds are having just as much problems as the125 beds.\"\u003c/p>\n\u003cp>Murphy and Selder don’t rate facilities, because, they say, individual needs are so different. They prefer to upload raw data. This year, they did something they've never done before: sponsor a bill. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\">AB 1523\u003c/a>, now signed into law by Gov. Jerry Brown, mandates all assisted living facilities carry liability insurance. While some owners of small facilities protested they won’t be able to afford the coverage, there’s wide agreement consumers have little recourse to address serious concerns given what many describe as light oversight from state regulators.\u003c/p>\n\u003cp>In a statement CARR issued after the governor signed AB 1523 into law, Murphy and Selder wrote that they hope the law encourages insurance companies to “weed out the poor performers” the state hasn’t managed to, and lead to the closure of facilities that are “un-insurable.”\u003c/p>\n\u003cp>The legislation was co-authored by \u003ca href=\"http://asmdc.org/speaker/\" target=\"_blank\">State Assembly Speaker Toni Atkins\u003c/a>, who represents San Diego.\u003c/p>\n\u003cp>\"I was absolutely shocked to learn that facilities didn’t carry liability insurance,\" Atkins says. \"I had a hard time understanding how any business, in this day and time, and particularly a business that deals with frail, elderly people, could not have liability insurance.\"\u003c/p>\n\u003cp>Speaker Atkins says the evidence presented by “the Chrises” helped build a data-driven case in Sacramento for substantive reform. \"Typically, as a legislator, you want to see the data,\" Atkins says. Murphy and Selder, she says, \"Set about compiling that data, and putting it front of people.\"\u003c/p>\n\u003cp>For those who wanted to see substantive reform of assisted living facilities in California, it's not clear yet how many of the original 17 measures will make it into law, how many were de-fanged in 11th hour rewrites. Schoch has drawn up a handy \u003ca href=\"http://centerforhealthreporting.org/article/bill-bill-assisted-living-reform-package\" target=\"_blank\">scorecard\u003c/a>.\u003c/p>\n\u003cp>\"A lot of it had to do with cost,\" Speaker Atkins says about what killed or altered reform bills in the waning days of the legislative session. She offers up \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\">AB 1454\u003c/a> by Assemblymember Ian Calderon (D-Whittier) as an example. It would have mandated annual, unannounced inspections of all licensed community care facilities, including assisted living homes. This would require more staff at the Department of Social Services, and thus, more money in the agency's budget. The Brown Administration did approve a bigger budget for DSS this year, but it's not a given it would be enough to guarantee annual visits. Atkins holds out hope for future budget boosts, though. \"California's making a turnaround as it relates to health and human service issues, but it's taking awhile,\" she said.\u003c/p>\n\u003cp>Murphy worries about how those bills that do make it into law will be interpreted by regulators. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, and then the regulators are going to come up with whatever they come up with.\" She wants to see the California Department of Social Services set up stakeholders meetings across the state, to ask what families and activists want to see happen next.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/268203311&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/268203311'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21266/two-women-on-a-mission-to-reform-assisted-living-in-california","authors":["251"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_825","stateofhealth_591"],"featImg":"stateofhealth_21273","label":"stateofhealth"},"stateofhealth_20825":{"type":"posts","id":"stateofhealth_20825","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20825","score":null,"sort":[1408382135000]},"guestAuthors":[],"slug":"the-assisted-living-reform-bills-that-died","title":"The Assisted Living Reform Bills That Died","publishDate":1408382135,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Bills that made it out of the Senate Appropriations Committee put the onus on assisted living industry.","status":"publish","parent":0,"modified":1525451712,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":783},"headData":{"title":"The Assisted Living Reform Bills That Died | KQED","description":"Bills that made it out of the Senate Appropriations Committee put the onus on assisted living industry.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"The Assisted Living Reform Bills That Died","datePublished":"2014-08-18T17:15:35.000Z","dateModified":"2018-05-04T16:35:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20825 http://blogs.kqed.org/stateofhealth/?p=20825","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/18/the-assisted-living-reform-bills-that-died/","disqusTitle":"The Assisted Living Reform Bills That Died","path":"/stateofhealth/20825/the-assisted-living-reform-bills-that-died","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20825/the-assisted-living-reform-bills-that-died","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_825","stateofhealth_2829","stateofhealth_3245","stateofhealth_591"],"featImg":"stateofhealth_20831","label":"stateofhealth"},"stateofhealth_20618":{"type":"posts","id":"stateofhealth_20618","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20618","score":null,"sort":[1407847856000]},"guestAuthors":[],"slug":"are-the-proposed-assisted-living-reforms-in-california-enough","title":"Are The Proposed Assisted Living Reforms in California Enough?","publishDate":1407847856,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A \"crime book\" maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls \"egregious neglect\" at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>\"There’s been a seismic shift in the population they serve,\" says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people \"who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.\"\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>\"I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She's since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. \"If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,\" he told reporters in the state capitol. \"But they kill her, and it’s $150.\"\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/162846042\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\"They’re going to create a medical expertise unit, with a nurse,\" Leary said. \"We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis -- we’ve been missing trends.\"\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet - build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of \"Deadly Neglect.\"\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. \"We find that they’re more of a facility protection agency than a consumer protection agency.\"\u003c/p>\n\u003cp>\"There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,\" Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>\"This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,\" she said. \"Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.\"\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. \"I mean it’s almost like 'what do you have to do to get closed?'\"\u003c/p>\n\u003cp>They've developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.\"\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento - at least, not this year.\u003c/p>\n\u003cp>\"We are behind the curve,\" Selder says. \"Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"\"We are behind the curve. Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"","status":"publish","parent":0,"modified":1525451423,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":1216},"headData":{"title":"Are The Proposed Assisted Living Reforms in California Enough? | KQED","description":""We are behind the curve. Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet."","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Are The Proposed Assisted Living Reforms in California Enough?","datePublished":"2014-08-12T12:50:56.000Z","dateModified":"2018-05-04T16:30:23.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20618 http://blogs.kqed.org/stateofhealth/?p=20618","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/12/are-the-proposed-assisted-living-reforms-in-california-enough/","disqusTitle":"Are The Proposed Assisted Living Reforms in California Enough?","path":"/stateofhealth/20618/are-the-proposed-assisted-living-reforms-in-california-enough","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A \"crime book\" maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls \"egregious neglect\" at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>\"There’s been a seismic shift in the population they serve,\" says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people \"who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.\"\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>\"I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She's since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. \"If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,\" he told reporters in the state capitol. \"But they kill her, and it’s $150.\"\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/162846042&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/162846042'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"They’re going to create a medical expertise unit, with a nurse,\" Leary said. \"We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis -- we’ve been missing trends.\"\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet - build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of \"Deadly Neglect.\"\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. \"We find that they’re more of a facility protection agency than a consumer protection agency.\"\u003c/p>\n\u003cp>\"There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,\" Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>\"This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,\" she said. \"Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.\"\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. \"I mean it’s almost like 'what do you have to do to get closed?'\"\u003c/p>\n\u003cp>They've developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.\"\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento - at least, not this year.\u003c/p>\n\u003cp>\"We are behind the curve,\" Selder says. \"Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20618/are-the-proposed-assisted-living-reforms-in-california-enough","authors":["251"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_825","stateofhealth_2829","stateofhealth_3245","stateofhealth_591"],"featImg":"stateofhealth_20634","label":"stateofhealth"},"stateofhealth_20532":{"type":"posts","id":"stateofhealth_20532","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20532","score":null,"sort":[1407241804000]},"guestAuthors":[],"slug":"online-information-about-assisted-living-facilities-hard-to-come-by","title":"Online Information About Assisted Living Facilities Hard to Come By","publishDate":1407241804,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20534\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid.jpg\">\u003cimg class=\"size-large wp-image-20534\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid-640x480.jpg\" alt=\"Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Lorchid Macri wasn’t sleeping. Her elderly mother was wandering out of the house in the middle of the night, forgetting to turn the stove off. Macri had to keep watch over her 24/7.\u003c/p>\n\u003cp>“Dementia is a cruel disease,” Macri says.\u003c/p>\n\u003cp>She says the stress of caring for her mother was overwhelming. It wasn’t until she landed in the hospital herself -- losing the sight in her right eye for 10 days -- that she was ready to confront the fact that it was time to place her mother in assisted living.\u003c/p>\n\u003cp>“It’s gut wrenching to put someone that you love and who has cared for you in a facility with strangers,” she says.\u003c!--more-->\u003c/p>\n\u003cp>Macri lives in central Oregon. But she wanted to find a home for her mother in Southern California where all of her friends and extended family live. Her search started where all consumer searches start these days: on the internet. She wanted to make sure the places she considered had no complaints lodged against them, no violations for neglect or abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There’s nothing,” she says. “You cannot find anything.”\u003c/p>\n\u003cp>Macri would have had to travel to a regional state office in Southern California and request paper copies of these reports. But from her home in Oregon, California’s website proved useless. \u003c/p>\n\u003cp>“I was dumbfounded at the fact that there were no methods to see if there were any reasons that I would not want to put my mom in any of these facilities,” she says.\u003c/p>\n\u003cp>She says the lack of meaningful information made an already difficult decision even more painful.\u003c/p>\n\u003cp>“You’re placing this individual that you love in a situation where you can only hope and pray that they’re going to be safe, secure, and well cared for.\"\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161847361&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>About a dozen states in the U.S. -- including North Carolina, Florida and Ohio -- make details about facility violations readily available online. California lawmakers say it’s an embarrassment that a state with the technical genius of Silicon Valley is so far behind.\u003c/p>\n\u003cp>At a press conference in January, Assemblymember Susan Eggman (D-Stockton) introduced a bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\">AB 1571\u003c/a>, that would require the state to build an online rating system where consumers can compare facilities on quality.\u003c/p>\n\u003cp>“We should not depend on Yelp when a loved one needs help,” she said.\u003c/p>\n\u003cp>The bill is one of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">several proposed assisted living reforms\u003c/a> currently pending at the State Capital. Lawmakers will vote on it this month, but it’s unclear if they –- or the governor –- will sign off on the million-dollar price tag.\u003c/p>\n\u003cp>“I don’t see how we afford not to do this,” Eggman says, though she conceded that the political will to back technology projects is lacking. “There’s always more needs than there is money. And the state’s encountered budget problems for awhile now. So upgrading technology is not at the top of anyone’s list.”\u003c/p>\n\u003cp>\u003cstrong>Prior Attempt 'Mind-blowingly Bad\"\u003c/strong>\u003c/p>\n\u003cp>This isn’t the first time the state has tried to build a consumer website for assisted living facilities. Several years ago, the Department of Social Services (DSS) received a grant to help collect information from facilities that could be posted online.\u003c/p>\n\u003cp>“The result was mind-blowingly bad,” says Tony Chicotel, an attorney with California Advocates for Nursing Home Reform, an advocacy group that monitors the assisted living industry and \u003ca href=\"http://www.canhr.org/legislation/rcfe_reform_act.html\" target=\"_blank\">is backing more than a dozen reform bills\u003c/a>.\u003c/p>\n\u003cp>The site only listed names and addresses of facilities. There were no details on services, cost, or past problems.\u003c/p>\n\u003cp>“For consumers, it was completely useless,” Chicotel says.\u003c/p>\n\u003cp>Part of the problem was resistance from the assisted living industry. Most facilities refused to provide information for a website, partly because the technology deployed by the Department of Social Services to collect the information was so bad. But facilities also objected to publishing anything about their rates, says Benson Nadell, program director for the San Francisco \u003ca href=\"http://www.sanfranciscoltcombudsman.org\" target=\"_blank\">Long-Term Care Ombudsman Program\u003c/a>.\u003c/p>\n\u003cp>“They want interested parties to call up and have an appointment with their marketing person,” \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> he says, adding that some sweet-talking salesmen want to prey on peoples’ guilt around placing their parents in a facility. “It’s like buying a car, particularly the nice looking places. They are quite enticing. And suddenly, money is no object.”\u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will Lawmakers Greenlight the Funding?\u003c/strong>\u003c/p>\n\u003cp>After more than eight years, the California's Department of Social Services finally added a new feature to its website in June. It now lists the number of complaints and citations lodged against a facility, but doesn’t say for what.\u003c/p>\n\u003cp>“It lacks specificity,” Nadell says.\u003c/p>\n\u003cp>Nadell says a database is only as good as the information entered into it. And here California has another problem. Current law only requires inspections of assisted living facilities every five years -- more frequently only if there’s a complaint. But there’s a constant backlog of complaints that haven’t been investigated. So a lot of helpful information isn’t even being gathered.\u003c/p>\n\u003cp>“Right now it’s pretty hopeless,” Nadell says.\u003c/p>\n\u003cp>The Department of Social Services says it’s trying. Chief deputy director Pat Leary says the agency wants to post more information online, but it’s hamstrung by outdated technology. The department uses Lotus Notes, a database program developed before the internet took off.\u003c/p>\n\u003cp>“We have an antiquated computer system that requires human beings to go in and collect data and create reports by hand,” Leary says.\u003c/p>\n\u003cp>A complete overhaul of the entire system is what’s really needed, advocates say, but the cost of that far exceeds what lawmakers are willing to spend.\u003c/p>\n\u003cp>So consumers like Lorchid Macri are basically on their own. She found a facility in San Bernardino that she thought would be okay for her mother. But it wasn’t.\u003c/p>\n\u003cp>“She lost 17 pounds in 6 months,” she says. “She was not showered daily as she was supposed to be. We often found her in room still in her nightgown at 2 or 3 in the afternoon.”\u003c/p>\n\u003cp>After two facilities in two years, Macri was fed up. She moved her mom back up to a place in Oregon.\u003c/p>\n\u003cp>“I did not want to see another facility in California, because I couldn’t research it,” she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Macri says she knows her mother is doing well now, because she’s stopped asking if she can come home.\u003c/p>\n\n","blocks":[],"excerpt":"A dozen states have information readily available online. California is far behind.","status":"publish","parent":0,"modified":1407345979,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://w.soundcloud.com/player/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1163},"headData":{"title":"Online Information About Assisted Living Facilities Hard to Come By | KQED","description":"A dozen states have information readily available online. California is far behind.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Online Information About Assisted Living Facilities Hard to Come By","datePublished":"2014-08-05T12:30:04.000Z","dateModified":"2014-08-06T17:26:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"20532 http://blogs.kqed.org/stateofhealth/?p=20532","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/","disqusTitle":"Online Information About Assisted Living Facilities Hard to Come By","path":"/stateofhealth/20532/online-information-about-assisted-living-facilities-hard-to-come-by","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20534\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid.jpg\">\u003cimg class=\"size-large wp-image-20534\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid-640x480.jpg\" alt=\"Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Lorchid Macri wasn’t sleeping. Her elderly mother was wandering out of the house in the middle of the night, forgetting to turn the stove off. Macri had to keep watch over her 24/7.\u003c/p>\n\u003cp>“Dementia is a cruel disease,” Macri says.\u003c/p>\n\u003cp>She says the stress of caring for her mother was overwhelming. It wasn’t until she landed in the hospital herself -- losing the sight in her right eye for 10 days -- that she was ready to confront the fact that it was time to place her mother in assisted living.\u003c/p>\n\u003cp>“It’s gut wrenching to put someone that you love and who has cared for you in a facility with strangers,” she says.\u003c!--more-->\u003c/p>\n\u003cp>Macri lives in central Oregon. But she wanted to find a home for her mother in Southern California where all of her friends and extended family live. Her search started where all consumer searches start these days: on the internet. She wanted to make sure the places she considered had no complaints lodged against them, no violations for neglect or abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There’s nothing,” she says. “You cannot find anything.”\u003c/p>\n\u003cp>Macri would have had to travel to a regional state office in Southern California and request paper copies of these reports. But from her home in Oregon, California’s website proved useless. \u003c/p>\n\u003cp>“I was dumbfounded at the fact that there were no methods to see if there were any reasons that I would not want to put my mom in any of these facilities,” she says.\u003c/p>\n\u003cp>She says the lack of meaningful information made an already difficult decision even more painful.\u003c/p>\n\u003cp>“You’re placing this individual that you love in a situation where you can only hope and pray that they’re going to be safe, secure, and well cared for.\"\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161847361&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>About a dozen states in the U.S. -- including North Carolina, Florida and Ohio -- make details about facility violations readily available online. California lawmakers say it’s an embarrassment that a state with the technical genius of Silicon Valley is so far behind.\u003c/p>\n\u003cp>At a press conference in January, Assemblymember Susan Eggman (D-Stockton) introduced a bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\">AB 1571\u003c/a>, that would require the state to build an online rating system where consumers can compare facilities on quality.\u003c/p>\n\u003cp>“We should not depend on Yelp when a loved one needs help,” she said.\u003c/p>\n\u003cp>The bill is one of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">several proposed assisted living reforms\u003c/a> currently pending at the State Capital. Lawmakers will vote on it this month, but it’s unclear if they –- or the governor –- will sign off on the million-dollar price tag.\u003c/p>\n\u003cp>“I don’t see how we afford not to do this,” Eggman says, though she conceded that the political will to back technology projects is lacking. “There’s always more needs than there is money. And the state’s encountered budget problems for awhile now. So upgrading technology is not at the top of anyone’s list.”\u003c/p>\n\u003cp>\u003cstrong>Prior Attempt 'Mind-blowingly Bad\"\u003c/strong>\u003c/p>\n\u003cp>This isn’t the first time the state has tried to build a consumer website for assisted living facilities. Several years ago, the Department of Social Services (DSS) received a grant to help collect information from facilities that could be posted online.\u003c/p>\n\u003cp>“The result was mind-blowingly bad,” says Tony Chicotel, an attorney with California Advocates for Nursing Home Reform, an advocacy group that monitors the assisted living industry and \u003ca href=\"http://www.canhr.org/legislation/rcfe_reform_act.html\" target=\"_blank\">is backing more than a dozen reform bills\u003c/a>.\u003c/p>\n\u003cp>The site only listed names and addresses of facilities. There were no details on services, cost, or past problems.\u003c/p>\n\u003cp>“For consumers, it was completely useless,” Chicotel says.\u003c/p>\n\u003cp>Part of the problem was resistance from the assisted living industry. Most facilities refused to provide information for a website, partly because the technology deployed by the Department of Social Services to collect the information was so bad. But facilities also objected to publishing anything about their rates, says Benson Nadell, program director for the San Francisco \u003ca href=\"http://www.sanfranciscoltcombudsman.org\" target=\"_blank\">Long-Term Care Ombudsman Program\u003c/a>.\u003c/p>\n\u003cp>“They want interested parties to call up and have an appointment with their marketing person,” \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> he says, adding that some sweet-talking salesmen want to prey on peoples’ guilt around placing their parents in a facility. “It’s like buying a car, particularly the nice looking places. They are quite enticing. And suddenly, money is no object.”\u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will Lawmakers Greenlight the Funding?\u003c/strong>\u003c/p>\n\u003cp>After more than eight years, the California's Department of Social Services finally added a new feature to its website in June. It now lists the number of complaints and citations lodged against a facility, but doesn’t say for what.\u003c/p>\n\u003cp>“It lacks specificity,” Nadell says.\u003c/p>\n\u003cp>Nadell says a database is only as good as the information entered into it. And here California has another problem. Current law only requires inspections of assisted living facilities every five years -- more frequently only if there’s a complaint. But there’s a constant backlog of complaints that haven’t been investigated. So a lot of helpful information isn’t even being gathered.\u003c/p>\n\u003cp>“Right now it’s pretty hopeless,” Nadell says.\u003c/p>\n\u003cp>The Department of Social Services says it’s trying. Chief deputy director Pat Leary says the agency wants to post more information online, but it’s hamstrung by outdated technology. The department uses Lotus Notes, a database program developed before the internet took off.\u003c/p>\n\u003cp>“We have an antiquated computer system that requires human beings to go in and collect data and create reports by hand,” Leary says.\u003c/p>\n\u003cp>A complete overhaul of the entire system is what’s really needed, advocates say, but the cost of that far exceeds what lawmakers are willing to spend.\u003c/p>\n\u003cp>So consumers like Lorchid Macri are basically on their own. She found a facility in San Bernardino that she thought would be okay for her mother. But it wasn’t.\u003c/p>\n\u003cp>“She lost 17 pounds in 6 months,” she says. “She was not showered daily as she was supposed to be. We often found her in room still in her nightgown at 2 or 3 in the afternoon.”\u003c/p>\n\u003cp>After two facilities in two years, Macri was fed up. She moved her mom back up to a place in Oregon.\u003c/p>\n\u003cp>“I did not want to see another facility in California, because I couldn’t research it,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Macri says she knows her mother is doing well now, because she’s stopped asking if she can come home.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20532/online-information-about-assisted-living-facilities-hard-to-come-by","authors":["3205"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_591"],"featImg":"stateofhealth_20534","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. 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