Not long ago, I inadvertently stumbled into a passionate discussion about senior living.

By Jack Cumming

Not long ago, I inadvertently stumbled into a passionate discussion about senior living. The prevailing perception was that since senior living is expensive, it must be highly profitable. One participant spoke of hearing senior living owners speak of a 60% profit on care.

The data, though, suggest otherwise. Many senior living operations have weak balance sheets with negative net asset positions. Anyone who has invested in Brookdale knows that the stock market doesn’t think senior living is so profitable.

Workers’ Plight

The opening to the discussion concerned the low wages, and high demand, for Certified Nursing Assistants (CNAs). The discussion starter was a person who took a job as a CNA after high school. She said the senior living reputation among her friends was: “They’re desperate and they’ll take anyone. You can always get a job there. They’ll train you and, after a year, you can move on to a hospital.”  

She went on to add that the workload is heaviest at the start and goes down from there. The workload in hospitals is much lighter, she added, than in senior living. Now I don’t know if that’s true or not, but the passion of the discussion showed that the perception is there. What resonated for me was, “They’ll take anyone, and after a year, you can move onto a hospital,” presumably, with a lighter workload and better job security.

Technology to the Rescue?

As is often the case, from that beginning, the discussion moved to other areas. Another person chimed in to report asking a senior living operator why they didn’t have an iPad-based order-taking system in the dining room. She claimed that the retort was, “That’s too expensive.” The questioner couldn’t understand how you could make a large investment in staffing the dining room and not automate the process as much as possible.

The former CNA, though, was still caught up in her experience from twenty years previous. She continued, “There were staff who took smoke breaks and staff who did the work. I had seventeen patients and the nurse in charge seldom left her station.”  

Another person chimed in, “I don’t think that we baby boomers are going to come to senior living unless they pay staff a living wage.” That hung in the air for a moment. My own thought was that I doubt that most baby boomers know much about senior living wages, but they do know about the cost to care for their parents.

Role of Government

With that, the discussion turned political. Was government intervention positive or negative? For instance, does CMS (Centers for Medicare and Medicaid Services) inhibit the deployment of more empowering wheelchairs, alternatives to walkers, etc. by the way they manipulate reimbursement rates. Is CMS a positive or inhibiting force for entrepreneurship and innovation in senior living?

One person, who favored government funding for long term care in a Medicare-for-all system, commented that government and politics slow down the adoption of new approaches until they are found to be safe. Opinions rapidly grew more vocal and clear partisan divides emerged among those in the discussion.

Economic Impacts

It was perhaps only natural that the mention of CMS led to a discussion of whether government should pay for senior living. One participant made a passionate case for shared responsibility for the high cost of socialized services like long term care.  

Another decried the deterioration in what a dollar will buy, which some economists attribute to continued deficit spending on well-intentioned causes. The disproportionate cost of medical care in the United States was mentioned.

The discussion began to move toward a close. There was a consensus that healthcare, and its long-term care component, is complex and difficult to address. The former CNA concluded: “[Long term care is] so expensive that it’s out of reach even for most middle-class people. And, I’m decidedly in the lower end of that class. For us, when we think of eldercare, we think first of family. I have a cousin who moved to Costa Rica where he could afford care for his wife. Those are our options – family or leave the country.”

What Do You Think?

Without doubt, this is a discussion that our nation has to have. One takeaway is that long term care is part of the overall healthcare challenge which America has struggled to address without sufficient success. The answers are elusive, but it was refreshing to hear people discussing the situation with mutual respect and concern for each other.