Recognising Depression in Older People

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Depression amongst elderly citizens is often dismissed as an inevitable part of ageing, but it is not good enough to just accept this as a fact of life when it doesn’t have to be the case. By maintaining positive mental and physical health, and with the right support from family and friends, people can continue to lead happy, fulfilling lives long past the age of retirement. If you notice some behaviors which could indicate the onset or existence of depression, now is the time to act. Talk to your elders and try to establish a roadmap as to how problems can be fixed.


Seniors in Flight: Protecting Yourself During Air Travel

 Image via  Pixabay

Image via Pixabay

Written by: Marie Villeza,

Few people look forward to air travel. Long lines, awkward security checkpoints, and cramped airline seating all but ensure that flying is an uncomfortable experience for everyone involved. For seniors, air travel can be especially inconvenient. Between physical limitations, health concerns, and travel crime targeting seniors, getting on a plane can sometimes seem like more hassle than it’s worth. But don’t let travel worries stop you from spending your retirement the way you’ve dreamed of. Instead, take these measures to protect yourself during air travel.

Avoid Getting Sick

Airplanes are a minefield of germs. With tight quarters and limited air circulation, it’s no wonder that up to 20 percent of people experience cold symptoms in the weeks following a flight. For the elderly, that cold could be more than a nuisance. Adults over the age of 65 are more susceptible to contracting the cold or flu, experience more severe symptoms than younger adults, and are more likely to contract pneumonia or even die as a result of their illness.

To protect yourself from unexpected illness, stay hydrated throughout your trip. Dry cabin air during flights makes it easier for germs to settle into your sinuses, but drinking plenty of water and rehydrating your nasal passages with a saline spray can help flush out viruses and bacteria. Wash your hands before eating, and bring a pocket pack of antibacterial wipes so you can clean off your tray table and entertainment console before using them. If your health is fragile for any reason, a face mask offers extra protection from airborne germs.

Protect Your Medication

If you take a daily medication, the last thing you want is to forget or lose that medicine when you’re en route to a destination hundreds of miles from your doctor’s office. Luckily, prescription medications are permitted in carry-on luggage.

Packing your medications in your carry-on luggage protects your health in the event that your luggage is lost or delayed. Pack medications in their original containers with the prescription label attached. Place prescriptions in a clear plastic bag with nothing else so they’re accessible at security checkpoints. If your medication or medical devices can’t go through the X-ray machine, ask for a visual inspection instead.

Keep Your Home Safe

Leaving your home unattended during travel leaves it vulnerable to vandalism and break-ins, but there are ways to protect yourself before you depart. Try to make your home appear lived-in during your absence. Place a hold on mail and newspaper deliveries while you’re gone, or ask a neighbor to pick up your mail each day. For potential burglars, lingering deliveries are a sure sign that a house is empty. Set lights on timers so it appears that people are inhabiting different rooms throughout the day. If you don’t have a garage, ask a neighbor to park in your driveway so it looks like someone’s home.

Don’t forget the simple measures for securing your home. Ensure that all doors and windows are locked before you leave, enable your security system, and tell trusted neighbors that you plan to be out of town. Every pair of eyes is an extra layer of protection for your home. If you’re able, ask someone to drop in occasionally to make sure everything is OK.

Countless seniors plan to travel the world during retirement. After decades of working, what could be better than jet-setting around the globe, seeing all the places you read about in your youth? But there’s more to planning a successful vacation than buying plane tickets and booking hotel rooms. With these tips, seniors can enjoy an adventure that’s both fun and safe.

Healthy Nutrition for Older People

The importance of a healthy, well-balanced diet cannot be underestimated, particularly for older people whose bodies need the right nutrition to prevent severe health problems from arising. Failure to maintain a healthy diet can result in complications such as heart disease, osteoporosis and cardiovascular disease developing quickly.

Unfortunately, elderly people are less likely than most to eat healthily, for a variety of reasons. They could find it too difficult to prepare proper meals every day or to get to the supermarket to buy the right nutrients. They may encounter a loss of appetite or a decline in their senses of taste and smell. They could forget what they last had to eat or when they last ate.

If you notice a deterioration in the dietary habits of your elders, you could intervene by educating them as to the nutrients they need (and those which they should avoid), or by bringing them to the supermarket with you and helping them with their food shopping. You could also cook some meals for them if they find this difficult or even bring the family around to enjoy dinner with elderly relatives once a week.

This infographic from Be Independent Home Care ( outlines how we can help our elders to eat healthily so that they will continue to feel good well into their senior years.

Falls Are the leading Cause of Death Amongst Elderly People

by: Derek Eastwood

Falls for people over the age of 65 can be fatal. Amazingly, 28%-35% of people aged 65 and over fall between 2 and 4 times every year. The issue is that a lot of these falls cause fractures and interestingly 87% of fractures in the elderly are due to falls.

This infographic from Hussey Fraser outlines what we can do to reduce to risks of falling. While there are some intrinsic risk factors, between 30% to 50% of falls are due to environmental circumstances such as poor lighting and slippery floors.

If you live with an elderly person try to look at what preventative measures you can take in the home to reduce risk of falling. Simple things like removing clutter and not having electrical cords spread across the floor could save someone’s life. Find out more about how to prevent falls now.

How Technology Keeps Us Safe

by Sarah Allen

In an ever-changing world full of technology and new age ideas, one thing that will never change is the need to stay safe. Thankfully, there are a number of resources that are designed for our modern, constantly evolving society and the new hazards that often come along with it.

This is why Nucleus and have teamed up to create an infographic that highlights some of the most innovative and technologically advanced products that can help keep everyone in the family safe in a world defined by the “Internet of Things” and smart homes.

Your Kids

Keeping your family safe is a top priority, and new technology is here to help give that peace of mind, including wireless security systems and safe driving apps. There’s also the amount of exposure kids have to new technologies, who often know how to use them better than their parents. Fortunately, there are now easy ways to control what kids can see or do on their devices.

Your Aging Loved Ones

For seniors who did not grow up with the technology their kids are so used to, there are products being designed with their changing lifestyles in mind — including medication management software and emergency response devices.

 When it comes to the fun activities of and engagement in everyday life, items like a home intercom system can keep families connected to one another without having to hassle with other apps or programs that come along with smartphones, giving the peace of mind to family members that their parents or grandparents are safe and doing well.  

 A home intercom and monitoring system would also be very helpful in remotely taking care of an aging loved one who may suffer from a condition such as dementia when relocation isn’t possible. In the initial stages of dementia, forgetfulness starts to become prevalent, but having the ability to keep your loved one engaged and constantly communicating can be of great benefit.

Your Pets

Most families consider their pets to be as much a part of the family as anyone else, which is why their safety is also a top priority. Thanks to technology, keeping your pet safe is easier than ever. For example, there are now countless ways to spy on your pet while you’re away, making sure they don’t get into any trouble.

Or, if your pet happens to escape your yard and run away, you no longer have to staple a picture on every telephone post in the neighborhood thanks to new tracking microchips and GPS trackers.

Check out the infographic below for more, and let us know in the comments how you and your family use technology to stay safe!

The Rewards of Having a Pet in Your Golden Years

written by Jason Lewis

Having a pet in the household can be a rewarding experience at any age. Seniors greatly appreciate the companionship and the social element of having a pet around the house. Maintaining a social bond is extremely important at any stage of life, and this is especially true during our Golden Years.

 Photo courtesy of Pixabay by  brenkee

Photo courtesy of Pixabay by brenkee

Over the years, multiple surveys have even indicated that community-oriented elderly adults view pet ownership as a very positive thing. Nearly every single person who was surveyed responded by saying that they feel some sort of social connection with their four-legged companions. 95% talk to their pet, 57% confide in their pet, and 79% take comfort in knowing their pet is around.

And having a pet need not be be a struggle. When bringing a new dog into your home, consider using a trainer to help you and your new pooch get acquainted with each other.

Aside from helping to establish routines, a trainer can teach effective techniques (i.e. commands, discipline, etc.) that will enable you and your dog to navigate your world together
a bit more easily.

Taking care of a pet changes the way we think and the way we care for ourselves. In fact, seniors who own pets have been shown to also take better care of themselves. Also, pet ownership might help improve mental sharpness and possibly even delay the effects of certain types of dementia, including Alzheimer’s Disease.

Pet ownership does more than simply provide emotional support and social connection for seniors. It might actually boost their health! Studies have shown that pet owners are less likely to experience high blood pressure or certain heart conditions.

Dog ownership in particular is good for promoting physical activity, even if just by encouraging people to take a few extra steps while walking their furry friend. According to the animal advocacy organization PAWS, dog owners are “way more likely” to hit their weekly exercise goals. In fact, some seniors have even started successful dog walking businesses as a way to stay healthy, earn extra income, and bring a smile to their faces during retirement.

Of course, not all seniors are able to walk their own dog - for a variety of reasons. This doesn’t mean that those seniors have to live a life without pets. Oftentimes, relatives or close family friends are willing to step in and assist with taking care of a beloved pet.

If there’s no one nearby who is able to assist, there are still probably some options. For instance, there are various dog walking services in just about every city; chances are, there’s one in your city who can help. These types of services allow seniors to maintain independence and continue happily living with their beloved pets, while someone else assists with dog walking. Hiring a professional dog walker can be quite a treat - for the dog as well as for the senior!

Life at any stage is unpredictable, and many seniors around the world enjoy the consistency and companionship of having a pet at their side each day. With all the research showing that pets are good for our health at any age, why not consider pet ownership during our retirement years? With professional dog walkers and other services to help seniors, owning a pet later in life is now easier than ever. Now, that’s something to wag your tail about!

Tips for Senior Caregivers: How to Get Your Loved One’s and Your Own Finances in Order This Year

by: Jason Lewis

When people think of caregiving for aging relatives, they often picture themselves helping with day-to-day tasks such as cooking, cleaning, doing the laundry, walking the loved one’s dog, taking them to the doctor, or even just spending time with them each day. While these are all important aspects of senior caregiving, many people often forget that managing your loved one’s finances is also a responsibility for many caregivers.

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  Photo courtesy of Pixabay by  TBIT

Photo courtesy of Pixabay by TBIT

Whether you are new to handling your parent’s finances, or whether you’ve been doing it for years, it can feel confusing, stressful and even overwhelming at times. “Handling my mom's finances wouldn't be too difficult, I thought,” writes financial columnist, Cameron Huddleston, “Boy, was I wrong.” The pressure of managing her mother’s finances was more than Huddleston had expected.

If Huddleston, a financial columnist, still feels overwhelmed managing her parent’s money, what about the rest of us? How can we proceed with getting our loved one’s - and our own - finances in order this year? Luckily, there are a few time-tested techniques recommended by experts to help us get our money situations in order, while saving our own sanity.If you’ve recently taken over the finances for an aging parent, grandparent or other relative, it can be helpful to ask them some basic questions regarding their money spending habits and their current financial situation. Among the types of questions you should ask, it is important to know the names of financial institutions as well as all bank account and credit card numbers. Be sure to find out if your loved one has a durable Power of Attorney (POA); if not, you’ll need to go to court to become a legal guardian before you can proceed with managing their money.

Once you’ve completed the steps of getting POA or guardianship so that you can handle finances for your loved one(s), you might want to consider hiring a professional money manager. The best thing about these professionals is that they can help you not only with your loved one’s finances, but also with getting your own finances in order.

There are several different types of professionals you could hire. A few examples include:


      Certified Financial Planners

      Daily Money Managers

From there, you can begin the task of managing both your own finances as well as the finances of your loved one. The same general rules will apply to both situations: you’ll want to collect and gradually pay down any outstanding debts, pay for any monthly bill or expenses, get property plans in order, and use leftover money to build a nest egg and save for the future. Document everything you do.

One last piece of advice to keep in mind: you’re just offering your help with certain areas of your loved one’s life, not trying to take over every aspect of his or her life. It can be tricky navigating all the various concerns that come up when you begin managing someone else’s money in addition to your own. Handling the situation with love, care, and respect will gently show your loved that you mean well and that they can trust you. That can make all the difference in the world when it comes to caring for your aging loved one.

Rise Above the Fear of Falling

By: Michael Leavy
Home Healthcare Adaptations

Falling is not a nice experience for anybody, but it is particularly frightening for older people, who are more likely not only to encounter a fall but also suffer serious injury or death from falling. In turn, they may feel fearful and apprehensive about simply being in their own home, and this fear can lead to a loss of self-confidence.

Therefore, those of us living with an elderly person have a responsibility to make the home as safe as possible in terms of reducing fall risk and to promote a sense of ‘I can’ over ‘I can’t’ in our elders. Older people shouldn’t be so afraid of falling that they are restrained from moving around their own home. It is up to younger family members to eliminate fall hazards insofar as possible and also to convince older people that they can move freely around the home. By pushing this positive mindset and encouraging our elders to partake in balance-improving exercises such as the chair rise, their fear of falling should subside and they will instead move around the home with confidence.

This infographic from Home Healthcare Adaptations ( in Ireland shows how you can minimize the risk of falling in elderly people. 

content and infographic provided by: Michael Leavy

Aging in Place Tax Credits Get a Step Closer

We have write-offs for energy efficiency, why not for aging efficiency?

July 20, 2016
by Richard Eisenberg

About a year ago, Next Avenue described a clever idea from Louis Tenenbaum, of, to create federal tax credits that would help people age in place safely and independently by subsidizing the cost of retrofitting their homes. The idea just got a baby step closer.

Recently, a (barely) bipartisan group of Congressional members introduced The Senior Accessible Housing Act (HR 5254, for the C-SPAN crowd), which would provide a tax credit of up to $30,000 to people over 60 for aging-in-place modifications to their homes, such as widening doorways for wheelchairs and installing ramps, nonslip flooring, handrails and grab bars. (The credit would be nonrefundable, which means it wouldn’t be of use to those who don’t owe federal income taxes.)

Many of these modifications don’t come cheaply. Ramps can run as much as $4,000, installing grab bars and level handles throughout a home can go for $1,500 and you can spend $1,000 or so to widen a doorway.

If you can stay in your home safely, that cuts down on falls, which cost patients and insurance companies $34 billion a year.

— Louis Tenenbaum

First Federal Bill for Homeowners to Age in Place

Tenenbaum, founder of the Aging in Place Institute, believes The Senior Accessible Housing Act is the first federal bill to incentivize older Americans to prepare their homes for aging in place.

He’s over the moon.

“I love it because it exposes the issue of individual housing that needs to be updated,” Tenenbaum told me. “This jumpstarts it to a national stage.”

The bill, supported by the Alliance for Retired Americans, was introduced by Rep. Patrick Murphy (D-Fla. and a Senate candidate) and Rep. Bruce Poliquin (R-Maine). Additional co-sponsors include Rep. John Conyers (D-Mich.), Rep. G.K. Butterfield (D-N.C.), Rep. Raul Grijalva (D-Ariz.) and Rep. Kyrsten Sinema (D-Ariz.)

Said Murphy: “With many older Americans living on limited incomes, home improvements to make their residences more accessible are often unaffordable. Making it easier for seniors to make these modifications means that they can stay in their homes longer without being forced to turn to assisted living facilities or nursing homes, which can often cost more.”

Of course, introducing legislation and actually passing it are very different things. And the odds of this (or nearly any) bill becoming law in this highly-charged election year are extremely slim.

But legislation has to start somewhere. And this is one bill that just might appeal to legislators on both sides of the aisle, since 88 percent of people 65 and older say they want to stay in their current residences as long as possible, according to AARP.

The Candidates and Aging in Place

I haven’t seen either Donald Trump or Hillary Clinton talk about ways to help people age in place — “It’s not on the national radar” says Tenenbaum. (Republican House Speaker Paul Ryan’s tax plan would eliminate nearly all tax credits and deductions, not add new ones.)

Bernie Sanders, however, called aging in place a “civil rights issue” at the Leadership Council of Aging Seniors Decide 2016 forum last February. “Clearly we should be doing everything that we can to provide resources to keep people in their own homes,” Sanders said. “Staying in their own homes is what most people would prefer and we should respect that.”

Problem is, although most older Americans want to age in place, their homes won’t let them.

As architect Duo Dickinson said at the HomeAdvisor Insights Forum on aging in place I attended last fall, “The undeniable reality is that the largest demographic bulge in America is processing through to a place where their homes will become a threat.”

Why America’s Homes Are Unfit for Older Americans

As I noted in an earlier Next Avenue post, the Bipartisan Policy Center says five universal design features can help make homes safer for older residents: no-step entries; single-floor living; switches and outlets accessible at any height; extra-wide hallways and doors to accommodate walkers and wheelchairs and lever-style door and faucet handles. But only 57 percent of existing homes have more than one of those features, according toHarvard’s Joint Center for Housing Studies.

For those who ask: “Why should the government help cover the cost of aging-in-place modifications?” my answer — and Tenenbaum’s too — is that these fixes ultimately save money.

“If you can stay in your home safely, that cuts down on falls, which cost patients and insurance companies $34 billion a year,” says Tenenbaum. (The figure is on the Centers for Disease Control and Prevention website.)

Also, Tenenbaum adds, when an older person is “rehabbing from an injury or illness or surgery, that’s often in an expensive rehab facility, because you can’t get back into your house.”

Lacking Savings to Live at Home Safely

Backing him up, and demonstrating the need for assistance such as aging-in-place tax credits: The Bipartisan Policy Center’s May 2016 report, Healthy Aging Begins at Home.

The report says: “Over the next 20 years, nearly 40 percent of individuals over the age of 62 are projected to have financial assets of $25,000 or less; 20 percent of those over 62 will have $5,000 or less. For many, this level of savings will be woefully inadequate to cover the expenses of daily living, never mind finance long-term services and supports or the modifications necessary to make living independently at home safe and secure.”

The Bipartisan Policy Center called for states and municipalities to “establish and expand programs to assist low-income seniors with home modifications through property tax credits, grants, or forgivable loans,” such as ones in Allegheny County, Pa.; Georgia; Virginia and Washington, D.C.

Don’t hold your breath, though. Tenenbaum concedes “it’s hard for us to grasp that some kind of spending now equals savings later.”

But that’s why we already have federal tax credits for making our homes more energy efficient. This year, you can claim 10 percent of the cost of certain expenses, up to $500, and 30 percent of the cost for things like solar energy systems and geothermal heat pumps.

If you want to show your support for HR 5254, check out Tenenbaum’s support letter template and write your Congressperson.

After all: if we can help people make their homes more energy efficient, why not help them make their homes more aging efficient?


This article can be found on Next Avenue's website here.

Respite Care: Why It Suits Both Caregiver And Patient

by Helen O’Keeffe
(all content and infographic in this post provided by

Caregivers are often so involved in caring for their patients that they neglect their own health, and the longer that continues, the more likely it is that the relationship between both parties can be harmed. Even though it may go against their innate, unselfish tendencies, there comes a point where a caregiver needs to say ‘stop’ and take a brief rest period for themselves.

If you provide regular care for someone and you find yourself becoming increasingly agitated, making poor judgements, feeling unusually exhausted or even losing your desire for caregiving, the time has come to take some respite. This can be for a few days or it can mean cutting back your caregiving time so that you have a few hours to yourself in the evening.

You’ll quite likely have forged such a strong sense of commitment to your patient that you could feel guilty about taking respite care. In the long run, it’s the best thing you can do. You want the patient to receive the best care possible, and if you feel so worn out that you can’t provide that for the time being, find someone else to take over for a short period. The patient can also benefit from temporary access to a fresh voice and, when you’re ready to resume caregiving duties, they’ll be delighted to see you back, not to mention the reinvigoration that you’ll experience.

It’s not a crime to know your limits and take a breather. As this infographic from Home Care Plus ( in Ireland shows, respite care is highly beneficial for both the caregiver and the patient. If you feel in need of a timeout, go for it. You’ve earned it from your enormous commitment to caregiving. 

Best cell phone and plans for seniors

Technology can be overwhelming, especially to seniors who are just learning how to use it. Just in the world of cell phones, there are so many different options (phones, plans, apps, etc.) that it can be sometimes difficult to sort through to find the best solutions. Certain phones make it easier for seniors to adapt to the idea of a cell phone and the safety benefits it can provide for the elderly. Verizon has composed a list of the best cell phones and plans for seniors:

For more details regarding plans please see Verizon's article here

Winter Weather Preparation

Have you ever been stuck on the road in a storm and had to pull over? Or do you remember the 2011 snowstorm in Chicago, which caused people to abandon their cars on the road? Winter storms seem to get more intense every year and with winter weather already here for parts of the country, it’s always good to remember that there are certain precautions you must take to stay safe. Blizzards can virtually stop cities; stranding drivers, delaying emergency responders, and even causing power outages. Usually, it is the elderly or very young who are most affected by the cold temperatures associated with winter storms. Many casualties are not directly related to the storm itself, but rather from the aftermath— elderly people stuck in their homes, heart attacks or strokes from shoveling snow, or car accidents due to unsafe roads. While it is difficult to estimate how much damage a winter storm can cause, it is possible to know when they will occur, and that vital piece of information will hopefully give you enough time to prepare.

Many people live in small towns and while this doesn’t mean total isolation during a storm, it could mean longer recovery time, so it is best to be prepared on your own. If you are at home during an extreme winter storm, make sure you have supplies that will allow you to stay comfortable and warm. If you have a fireplace, keep a pile of firewood available in case the heat goes out. Canned or non-perishable food will come in handy in case you lose power and the roads are snowed in. Emergency equipment such as flashlights and electric generators should be prepared for use and in working order.  Keep bottles of clean water for drinking and cooking because your pipes can freeze.

When you are at home, weathering the storm, you will want to receive the latest weather updates. Luckily, many smart phones automatically update users on any weather warnings, but if your phone does not do this, then you should manually sign up for weather alerts on your mobile phone or email. The Weather Channel offers free weather alerts for any area on their website. However, if the internet goes out, have a radio readily available as well. All of your mobile devices should be charged in case of a power outage.

Mobile devices and landlines are extremely important for older people who live alone. Your family, wherever they may be living, will want to know that you are safe. If they live in another state, designate a friend or neighbor as an emergency point of contact. If you are an older person that lives near loved ones, it could be a good idea to group together at one location.  Locate a place for everyone to meet when a winter storm warning is issued, depending on where you and your family are.

You should also make sure your home is ready for the winter. For example, be sure that your home’s walls and attic are properly insulated to avoid losing heat. To prevent your pipes from bursting, keep your faucets dripping. It is also important to know how to shut off your home’s water valves in case a pipe does burst. Set up emergency heating equipment, such as a fireplace with wood or a portable stove with plenty of fuel. Space heaters are helpful when used correctly. Keep your space heater at least three feet away from all furniture, flammable objects, or drapes. If no one is present in the room, turn off the heater. Never place any objects directly on a heater.

If you do need to travel in extreme conditions, or if you are stuck in the middle of a storm in your car, make sure that it is properly fitted to drive. Have your car’s radiator system serviced, use antifreeze in your car, and check your windshield wipers. If your tires have worn-down tread, replace them. It is also recommended that you keep jumper cables and chains in your car. These steps should help you stay safe during the cold winter months, and prevent an emergency from occurring.

Written by guest blogger: Jacob Edward 

Jacob Edward is the founder of Senior Planning and Prime Medical in Phoenix, Arizona. Prime Medical Alert not only operates in Arizona, but across all fifty states, including Maryland. In his spare time, Jacob enjoys dining out and supporting his alma mater Arizona State's sports teams. Jacob lives in Tempe, Arizona.

IAHSA China - JSR Associates' Experiences in China

For those watching the development of China’s senior housing industry, a handful of pilot projects have garnered a lot of attention. Those of Cascade (Emeritus), China Senior Care, and Merrill in particular each come to mind. Being a pioneer isn’t easy, and each of the companies has shown the grit and determination to push through a lot of unknowns in order to build projects designed to validate that their business model can be successfully deployed in China. These operators many times garner the most attention, but their efforts are supported by, and made possible through, similar efforts to understand the China market’s unique needs on the part of a variety of service firms. One such example is JSR Associates, who has been working with China Senior Care (CSC) for the past three years as CSC develops its business plan and care model. JSR’s Principal and Founder, Jane Rohde, recently agreed to share her experiences in advance of the presentation she will be providing at the upcoming IAHSA annual conference in China (register here!).

JSR Associates has provided senior living design and consulting services for over 17 years for new, renovated, and repositioned senior living projects. These include continuing care retirement communities (CCRC), adult living communities, independent living settings, assisted living projects, adult day care, and skilled nursing projects in the US and, most relevant to the upcoming IAHSA conference, in China. JSR’s goal during the strategic planning and programming process is to overlay the plan and concepts with current trends in senior living, reimbursements, staff needs and operational function, culture change, and care models to meet the future needs of current residents, as well as the next generation of residents. These challenges are particularly acute in a market such as China where much of the operational variables are either not known, or are being built on assumptions that may prove to be in need of additional localization.

Building on their roughly three years of work with CSC, Jane added, “I have found that the basic questions to ask in regard to design, is how is the facility going to be programmed, what is the care model, and what is the design regulatory process for development of design and construction documents? Their needs to be an integrated design process that assists with developing an operational plan, as there is no Chinese benchmark for senior living projects. What I’ve seen is that all newly constructed facilities are built as tenant fit-out projects; so in order to provide a physical space environment, there needs to be a programming development phase with expertise from both the US and China that work together to establish the function of the environments. Prior to the finalization of the construction documents for the infrastructure, a programmatic layout has to be developed based upon the care model and all operational functions planned for the facility.” I would also submit that among the reasons the CSC project in Hangzhou is important is that, as Jane references, it will not be a rehabbed site; rather, it will reflect conscious design and programmatic choices made from – quite literally – the ground up, capturing what CSC and JSR believes will best serve the Chinese consumer.

Given what Jane has seen in China, she believes there “is also a demand for need-driven extended care; which includes skilled nursing and memory care. Independent living is starting to be developed, but this is choice and lifestyle driven. A Chinese elder would need to decide with their child if and when they would be making a change; versus skilled nursing and care for those with dementia, which is need driven.” She added, “There are also opportunities for evaluating higher end, as well as a middle income solutions, for Chinese families, as elders age.” That was music to my ears given my own fears that too many foreign operators are looking past the middle-income market, leaving it for the domestic Chinese players (specifically insurance companies) to focus on.

Much of what will shape Jane’s presentation at IAHSA is advice she has for foreign operators and investors who want to pair off with Chinese developers. With this in mind, I asked her what she felt both sides needed to keep in mind. Jane pointed out that in the US, “[what we have] learned has resulted in the recognition of needing flexibility in care models and adaptability to acuities as people age, regulatory barriers when providing resident-centered care environments, and provision of multiple types of care within one setting. These lessons can be applied to China, as the industry is in its infancy; therefore allowing the needs and care models to drive the licensing process.” Jane echoed concerns most of us in the sector have had about accessing trained staff: “China has a need to evaluate the need for educational programs in geriatrics and dementia, as there are few potential staff trained in any type of long term care, activities, and person-centered care provision.” In addition, Jane ended her comments on what I think is a particularly important insight: “There is a concern that Chinese developers are looking to architectural firms to provide designs that are similar to the US; however prior to engagement of the design of the building, most Chinese developers need operational and care model guidance. Without this coming first, buildings are being built and operators sought, without having facility design input. This is providing inefficiency and could also prevent a resident-centered care model to maximize resident positive outcomes; which is needed to fulfill filial piety.”

Given Jane’s experience in both the US and China, I wondered what she is most interested to see transferred from the US to China. She pointed out six factors: “Furthering the utilization of the Senior Living Sustainability Guide® ( as a means to develop resident centered-care; resident-centered care as a standard of care (versus institutionalization); household and small house models that can serve a variety of acuity levels; provision of adult day care models coupled with extended care; provision of home healthcare services that support residents living with family or in the community at-large; bring back to the US best practices based upon bench-marked research and data from China residential aged care communities to be able to improve US models.” If that last point surprises you, it shouldn’t. After all, China may have some things to teach America about community care in particular that have been overlooked given America’s historical affluence, an economic reality being tested as our Baby Boomers begin to retire themselves.

Posted on October 7, 2013 - Written by Benjamin Shobert

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