Genworth Financial released its annual report analyzing long-term care costs across the nation. According to the report, the median annual rate for a resident of an assisted living community is $39,600.  The median annual rate for a private room at a skilled nursing facility is $81,030, while the median annual rate for a semi-private room is $73,000. These numbers reflect a greater disparity of costs than were seen in last year’s survey. The cost of assisted living rose just 1.19 percent over the last year. While the cost of a private room at a skilled nursing facility increased 4.23 percent, and the cost of a semi-private room at a skilled nursing facility increased 3.63 percent over the same period.

The survey also documented state-by-state data. Alaska has the highest private room skilled nursing costs and Oklahoma has the lowest. The median rate for a private room at a skilled nursing facility in Alaska costs $232,505 annually, while the rate in Oklahoma is $53,597. New Jersey, with a median annual rate of $68,556 has the highest rate for assisted living, while Missouri has the lowest rate, $29,025 annually.

Read the full report: The Genworth 2012 Cost of Care Survey to learn about your state’s long term care costs and nationwide statistics.

The report, created by the non-profit Center for Housing Policy, states that many of the senior housing challenges we are facing now, will be exacerbated in the coming years. The report predicts that as the population ages more people will be living with a disability and will not have access to affordable housing options. Currently 64 percent of households, in which the oldest member is 85 or older, contain a person with a disability. Poorer households are more likely to be affected by a disability and less likely to have the funds to move into assisted living or retrofit their homes to accommodate the disability. If this percentage remains stable, a larger number of seniors will be without adequate support.

The report points out that even seniors without a disability are likely living in an inappropriate setting. “Even if in good physical condition, many housing units may be neither safe nor suitable for older adults,” reads the report. “Hazardous bathrooms, steep staircases, narrow halls and doorways, and dated electrical systems may pose hazards to those with difficulty getting around, even among units otherwise deemed ‘adequate’ in the American Housing Survey.” In fact, each year one in three adults aged 65 or older falls and more than half of these falls occur at home.

Currently, 7 percent of Medicare beneficiaries over the age of 85 live in community housing with supportive services, like assisted living. 15 percent of seniors in the same age group live in a nursing home or other long-term care facility, and 78 percent live in a traditional community. The authors of the report advocate that more supportive housing options and programs to help make options affordable to all seniors will be needed to meet the rising demand over the coming years. The report also urges that the Home and Community-Based Services Medicaid waiver program be expanded and other programs be implemented to help low income seniors have access to safe and affordable housing.

Read the full report: Housing an Aging Population, Are We Prepared?

The Kaiser Family Foundation and Georgetown University have released a policy brief that advocates for a holistic perspective on entitlement programs. “As policymakers consider options for decreasing spending on entitlement programs, it is important to consider the overall and interrelated effects of policy proposals on seniors’ ability to pay for needed health care and essential living expenses,” said the authors of the brief. The brief goes on to expand upon the various issues that must be considered when revising policy for any entitlement program. 

The issues include seniors’ heavy reliance on Social Security, the high proportion of seniors’ budgets that are spent on medical costs, the need for long term services and supports, and the inability of many seniors to pay for long term care.

The brief points out that only 10 percent of seniors have long term care insurance, while two-thirds of those over age 65 will need some form of long-term services and supports, such as assisted living, during their lifetime. Low- and middle- income seniors frequently deplete their savings and rely on Medicaid. In fact, one-third of Medicaid spending covers long-term services and supports.  If no changes are made, these costs are likely to grow. “Many seniors will continue to face a risk of financially catastrophic long‐term care costs,” reads the report. “If current trends continue, most seniors in the future will not be insured for long‐term care costs and face the risk of high out‐of‐pocket costs and unmet needs.”

Read the full issue brief: Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors.

The nation is gearing up for an impending “silver tsunami,” and part of that includes making sure senior housing communities are prepared to care for a growing number of seniors with memory impairments.

One trend that’s becoming increasingly common: assisted living communities that didn’t originally offer memory care services are now making moves to provide them.

But memory care is very different from assisted living care, and factors such as financing, loan terms, and structural design requirements for the best quality of care make renovations or expansions a very complicated process.

The need: Alzheimer’s by the numbers

The nation’s 65+ demographic, which currently accounts for 13% of the overall population, is expected to more than double by 2050 to more than 89 million (and 20% of the population), according to the U.S. Census Bureau.

The need for memory care programs is projected to increase substantially too, with the number of 65+ Americans diagnosed with Alzheimer’s disease expected to rise from 5.1 million in 2010 to 13.5 million in 2050, according to estimates from the Alzheimer’s Association.

That translates to more than 15% of the 65+ demographic having an Alzheimer’s diagnosis within the next forty years.

“[Memory care is] in huge demand,” says Dana Wollschlager, director of real estate development for Ecumen, a company based in the Twin Cities, Minn. area that owns, manages, and designs senior living communities.

Including memory care as a service offering is vital for Ecumen and the companies with which it works.

“Every one of our projects currently under development for third-party developers includes memory care units,” she says, listing projects in Tennessee, Nebraska, Michigan, and Washington state.

Converting or adding units to existing communities

Adding Alzheimer’s or dementia care capabilities to an existing assisted living building is a way to allow residents to remain in their community and age in place, and can be done in a few different ways.

Operators can choose to convert existing units to memory care, add an extra wing designated for memory care, or do ground-up development of a separate building located either on an existing campus or somewhere nearby.

An Ecumen-owned community that will re-open this summer, for example, recently transformed a two-story transitional care building by putting all the transitional care units on one floor, and converting the second floor to memory care.

But whether a senior housing provider chooses to go the conversion, expansion, or development route, adding these services is fast becoming a necessity, and Paul Mullin, vice president of development at Silverado Senior Living, a senior housing provider that specializes exclusively in memory care, estimates there are currently less than two or three thousand memory care units under development nationwide.

“The model of dementia/Alzheimer’s care is the future of senior care, because there’s a lack of supply,” says Trisha Kellogg, marketing director for Sunshine Gardens Senior Communities in Durango, Colo., and senior executive vice president of marketing for Trinity Innovative Group.

However, the way that it’s added is very important, Kellogg says. If senior living companies are looking to renovate to include memory care, it’s important that residents don’t feel like they’re in a locked, institutional-like community, which can potentially increase stress levels for those in advanced stages of memory impairment, she says. In order to be successful at caring for the resident, there needs to be a home-like model.

“Long-term care is changing,” Kellogg says. “We’re not expecting the institutional feel any more. If it’s just going to be an addition, that addition had better be something special.”

But while it’s possible to add wings or convert a floor into a locked memory care unit, this isn’t always the best choice, says Mullin.

“Developers and operators need to be very cognizant of how they do it and how they operate it,” he says. “[Renovation] can be a limiting option, because many times, residents in locked environments get behavioral. The long-term viability of that resident staying in place and aging in place is not very realistic.”

What memory care should look like

Kellogg is seeing an emergence of stand-alone memory care communities, rather than just adding some units to an existing community, because it allows for a more purposeful design.

Her company has a 70-bed assisted living community in Colorado, with a smaller, 15-bed Alzheimer’s care building located about 15 miles away. When residents get to increased stages of Alzheimer’s or dementia, they tend to become overwhelmed by the large community, Kellogg says. 

At that point, they’re moved to the smaller, specially-designed building that’s easier to navigate and has a more home-like feeling.

There are many physical concerns when it comes to designing or repurposing a building meant for memory care, says Mullin.

“The layout of the building needs to lend itself to somewhat of an open floor plan that allows easy circulation—no dead-end hallways, no locked doors,” he says, pointing out two potential frustration-inducing triggers. “Our buildings are usually in the form of a large rectangle, with a circular path.”

Single-story buildings are preferable, as are properties with a few acres of land. “We look for available outdoor space, which could be an internal courtyard,” he says, as it’s ideal for gardens and walking paths.

Some companies, like Ecumen, design their memory care units primarily as studio apartments, but others, like Silverado, prefer a semi-private model.

Both agree that residents should be spending a majority of their time in common areas, not “holed up” in their rooms.

Because engaging in social programming and sensory activities is such a large part of memory care, these common areas are crucial, and should create a home-like, not institutional, environment, Wollschlager says.

Features of Memory Care Services

Caring for residents with memory impairments looks significantly different than assisted living care.

Memory care often requires a higher staffing ratio, says Mullin, and at Silverado the ratio of full-time employees to residents is about one-to-one.

“There needs to be commitment to staff on a level that’s appropriate for people that need a lot of care,” says Mullin. “It’s a huge commitment, and a huge expense in salary—and you have to charge a very premium rent.” He says Silverado communities charge anywhere for $5,000 to $7,000 a month for its semi-private rooms, with a “big chunk of that” going toward staffing.

“It’s important to create purposeful activity stations throughout those spaces so that residents can stimulate memories and the five senses,” says Wollschlager. “[Ecumen] tries to create an environment that encourages them to maintain their long-term memories; it can help keep residents less agitated and more engaged and focused.”

Ecumen activity stations include older-era dress patterns or recipes that can be sorted through, and small “activity kitchens” with laundry stations where residents can fold towels and other items.

At Silverado communities, residents have their own “memory boxes” that are located outside of their bedrooms, says Mullin. These contain mementos from a resident’s life and can include photos or items representing family, hobbies, and various other interests. They can help spark a resident’s long-term memory and can be used to identify bedrooms.

Outdoor space should include various walking path surfaces, says Mullin, such as cement, grass, or gravel that serves to stimulate leg muscles.

Financing for memory care renovations and expansions

As with most types of development, obtaining the financing to renovate assisted living to include memory care units isn’t the easiest process.

“Financing is tough right now. There are so many factors for getting loans,” says Wollschlager. “It’s tremendously complicated.”

Banks are looking for greater equity requirements, and in many cases require owners to come to the table with about 25-35% of the project’s funding in cash, she continues, and this can be “really tough.”

Still, people are getting it done, she says, and sometimes with the help of the Department of Housing and Urban Development (HUD), whose Section 232 program provides loans for memory care development, in addition to assisted living and skilled nursing.

Fannie Mae has been fielding several requests from borrowers via the enterprise’s lender-partners to convert existing units to Alzheimer’s care or expansion, says Christopher Honn, director of Fannie Mae’s senior housing group.

Borrowers with have an existing loan that’s been bought by Fannie Mae can request to make such a change, which must be approved by both Fannie Mae and the lender.

For the most part, these renovations or expansions are funded by borrower equity, and according to Honn, Fannie Mae has found a “very efficient way” to approve and structure these transactions.

In other cases where there’s a new loan request, and there’s enough cash flow and operating income from the property to potentially finance some of the costs of the renovation, then Fannie  Mae will look into financing it with a brand-new first mortgage.

However, it’s much more common—and efficient—for existing borrowers to formulate a plan for their lenders based on market demand that’s then presented to Fannie Mae, and funded with the borrower’s own equity cash, Honn says.

The future of memory care

The nation is facing a growing need for memory care, and many senior living communities are renovating, converting, expanding, or developing so they’re able to keep up with demand.

“[Adding memory care capabilities] is a big industry trend right now, and it has been for several months now,” says Honn.

For those who are planning on adding these services, senior care developers caution that the design, structure and available amenities of a community are crucial for properly housing and caring for individuals with memory impairments, and renovation projects need to reflect this.

Interested in learning more about Memory Care?  Join your peer executives at COMMUNITY 2012, the ALFA Conference and Expo.  Learn all about it http://www.alfa.org/alfa/default.asp.

Researchers at the University of Texas at Austin studied older adults with prehypertension or stage 1 hypertension who were not on any medication. Half of the participants took part in 12 weeks of swimming exercises and the other half performed gentle relaxation exercises during this time. Each group participated in its assigned activity three to four days a week for 15 to 45 minutes a day.

At the end of the study, the swimming group’s systolic blood pressure fell 7 percent and their arteries became more elastic and responsive to changes in blood pressure. The group that performed relaxation exercises showed no statistically significant improvements. Researchers noted that this study indicates one more benefit of swimming for older adults. Since swimming minimizes weight-bearing stress and is unlikely to lead to overheating, swimming is an ideal exercise for older adults whether or not they have high blood pressure, said researchers.

Read the study: “Effects of Swimming Training on Blood Pressure and Vascular Function in Adults >50 Years of Age”

The seniors housing market enjoyed a blockbuster year in 2011, with merger and acquisition activity reaching its highest level since the sector’s peak years of 2006 and 2007.

The $25 billion worth of transactions were conducted primarily by real estate investment trusts (REITs), which were responsible for almost $20 billion of those deals, according to the National Investment Center for the Seniors Housing & Care Industry (NIC). 

If 2011 was the year of the mega-deals, smaller, regional communities will be the acquisition targets of the next 12 months, industry experts say.

Buyer vs. Seller

Buyers are seeking a few specific qualities in today’s senior housing market, says Rob Reis, San Francisco-based senior associate for senior living brokerage firm Marcus & Millichap. 

The ideal assisted or independent living communities are 15 years old or newer and are located in large metropolitan areas such as Seattle, Portland, Chicago or Dallas, Reis says. Sellers look for in-place cash flow and strong occupancy performance that allows them to ask a premium at a cap rate around 8%, often getting multiple offers on the table. 

Average cap rates have seen a moderate increase over the course of the last year after falling sharply from 9%-plus to below 8% in 2010, according to NIC. Today, the average cap rate hovers around 8%, the latest NIC data shows. 

Buyers benefit from these scenarios in their upside potential, Reis says. An ideal situation may be where an 80- to 100-unit property is 85% or 90% occupied, but with a margin less than 30%. 

“That is a great opportunity for those buyers waiting with cash ready to go, or who have a relationship with a REIT or access to FNMA financing. They can look at the property and see that occupancy is OK, but can be improved, and that margins can be increased to 35% or more,” says Reis. 

Private pay is preferred, due to its lack of exposure to government Medicare and Medicaid policy and reimbursement changes. Buyers also look to cases where they can improve occupancy, says Ben Firestone, a senior associate with Marcus & Millichap at its Chicago office, considering the 88.2% national average occupancy rate for senior housing properties, according to NIC.

“Buyers really like upside. Is there occupancy upside? Can you increase the level of care and cut expenses?” Firestone asks.

Seller motivation is still driven by the same factors—a life changing event, partnership issues or other opportunities. For those who did not have to sell immediately, however, they are well positioned in today’s market. 

“What may have changed is that three years ago someone in that situation might have been able to hold on,” Reis says. “Now, they can look out and say, ‘Occupancy has been good. We’re able to keep this place full without major discounts on rent. Let’s take it out to market.”

Leave Distress in the Past

The biggest change over the past few years, according to many working on transactions, is that the distressed properties today are not having too big an impact on the greater market. This opens opportunities for higher quality properties and sellers who are not as desperate to make the sale. 

“Since 2008, I think people thought there would be a lot more distress. It’s not that there haven’t been distressed properties, but they tend to be concentrated in several large portfolios and not disbursed,” says Jeff Davis, president and CEO of Chicago-based Cambridge Realty Capital Companies. “Combined with banks being reluctant to sell some of their assets, it created an environment where people thought there would be more distressed properties than there actually were.”

These large portfolio deals can be seen in a joint venture between Emeritus and Blackstone Corp., when they agreed in 2010 to buy a $1.2 billion portfolio of more than 140 Sunwest properties out of bankruptcy. 

“In the several years leading up to 2011 there were few high-quality assets coming to market,” Reis says. “That changed in 2011. Although there were some broken development projects, there were quite a few stabilized, well-maintained properties that traded hands. These communities had cap rates in the range of 7.5-8.5%.” 

There has been some perception change, however, as a result of REITs buying other REITs or strings of large operating companies. While it may not have a direct impact on the small seller, it can still have some bearing. 

“It does have an effect where the perception out there is better,” Reis says.

Buying Power

REITs have changed the landscape with their buying power in recent years, having accounted for more than three-quarters of sales activity in the senior housing sector last year according to NIC. But their strategy tends to differ from other buyers in the market. 

“Our strategy has been very consistent,” says John Cobb, chief investment officer for Ventas REIT Inc. “We’re focused highly on private pay senior housing. Usually Class B, or Class A, that’s our main focus.”

A good deal might not have any particular specifications in terms of occupancy, location or financing, but rather, the operations are the essential component, Cobb says. 

“There are some banks and others that might say we are only interested in ‘X’ percent occupancy,” he says. “We have over 100 operator relationships. We like better properties, better operations, we like to be full.”

Smaller deals have also garnered new interest after institutional investors like private equity firms and REITs recapitalized the majority of larger opportunities in the market.

“Now, given the institutions’ continued need to place capital in the marketplace, they are willing to seek out relatively smaller deals that would have been less attractive relative to an available mega-deal,” Firestone says. 

Ventas, for example, acquired a single-property Arizona assisted living community from Milestone Retirement for $7 million in March 2011. That transaction represented a smaller deal for the large REIT. 

“Smaller deals have become more attractive,” Firestone says. “The seller of a small company is now in a better position. Now there’s an opportunity for regional and smaller players to capitalize.”

An instance of this can be seen in the sale of Tiffany Court, a 15-year-old 57-unit building with consistent high occupancy and a great reputation in the community, which Reis brokered in December 2011. The San Francisco-area property was previously operated by a husband and wife team who sold it in order to move on to a new venture. 

“The buyer, SHPT, saw the value in the location and the strong operational history,” Reis says. The property sold at 95% occupancy for $11.3 million, or $198,246 per unit. 

Still, market hasn’t lent itself to easy transactions. 

“Nothing is easy anymore given the last few years,” says Cobb. “We take our time and try to find good operators. They need to get to know you and you need to get to know them. Very rarely do we walk fresh into a client and do a deal overnight.” 

The number of deals may not return to its previous level, but volume projections are steady for the coming year. 

“The volume of sales is not going to be what it was,” Firestone says, “but probably the number of sales will be relatively consistent.”

New Opportunities

Looking back at several years with little conventional financing and still next to no new construction financing, the sector appears well positioned as demand for senior living communities is stable. 

“There are a lot of deals out there that are good for both the buyer and the seller,” Firestone says. “We can make a match where it’s not a zero sum game.”

Sellers are able to get a price they feel is sufficient and buyers see opportunity in reshaping communities to meet higher acuity level needs. 

“It might be taking an independent living community and licensing some units for assisted living, then taking assisted living and converting a portion of those units to memory care. I see that in all markets,” Reis says. 

“The sector has performed strong versus other businesses,” Davis says. “It’s not that different from how it was in the 2005-2007 period.”

The property quality is an important driver in today’s climate, as occupancy has risen steadily in both assisted living and independent living communities since 2010, with demand now outweighing supply. 

“The variable being satisfied that wasn’t the case a few years ago is the quality of properties. We saw them coming to market last year, and this year and continue to see them,” Reis says. “That is what satisfies a good deal for the sellers and buyers out there.”

Looking for your good deal in seniors housing?  Or, just curious about the latest in debt, equity and other financial tools hot right now in senior living?  Register to attend COMMUNITY 2012, the ALFA Conference and Expo.

Most individuals residing in assisted living communities consider themselves to be at home, free to make the same sorts of lifestyle decisions available to them were they to live outside of a designated retirement community. But what about the repercussions a senior living provider could face if a resident wants to make an end-of-life decision relating to his or her health and well-being?

Back in August 2011, the story of an elderly couple living in a New Mexico retirement community made national news when they decided to halt their food and fluid intake (known as Voluntarily Stopping Eating and Drinking, or VSED)—and their assisted living community tried to evict them as a result.

Though instances of VSED are extremely rare, the case brings up a question that may become increasingly relevant with a rapidly aging population: How should senior living communities handle residents’ end-of-life decisions?

Do Assisted Living Residents Have Autonomy?

The New Mexico community’s management said in a statement at the time that if a resident “requires alternate placement, medical attention, or a level of care beyond the community’s capabilities, we have an obligation to notify a medical provider.”

However, some argue that if residents have previously and clearly expressed their end-of-life wishes, including the plan to stop eating and drinking, then they should be allowed to do so while remaining in their chosen residence.

“You expect the rights and the privileges that come with being in your own home,” says Barbara Coombs Lee, president of Compassion & Choices, a national non-profit organization dedicated to ‘expanding and protecting the rights of the terminally ill.’

“What we would like is the kind of forethought and policies that would allow those communities to be welcoming and nonjudgmental for legal decisions,” she continues.

If a resident has an advanced directive, or “AD,” that expressly indicates his or her end-of-life wishes, then senior living administrators should honor that, Coombs Lee says.

It’s a good idea for residents to have consulted a primary care physician and to talk with management at a community ahead of time about their end-of-life wishes, she says. Their AD should be completed, up-to-date, signed, witnessed, and be readily available and present for staff to see were a situation to arise.

What are the Provider’s Responsibilities and Risks?

From a provider’s point of view, the navigation between a resident’s wishes, the community’s liability, and industry regulations can get pretty tricky.

“As providers, we’re always trying to make sure we communicate well and understand the needs and desires of our residents,” says Michelle Hamilton, senior vice president and chief of assisted living operations at Country Meadows Retirement Communities, based in Hershey, Pa. “It’s a careful walk, with trying to manage the resident’s dignity and their independence, but also at the same time being a good steward and watching out for that person and their family, and watching out for the company.”

Most of the time, residents at Country Meadows communities aren’t at a point where end-of-life decisions are big issues, says Hamilton, as they usually transfer to skilled nursing or hospice care before then. And while the company doesn’t require incoming residents to fill out ADs, they’re strongly encouraged to do so.

In cases where residents decide to enact certain plans with the intent of ending their lives on their own terms, it’s extremely important to closely examine each individual case, determine competency, and allow for the possibility that they may end up changing their minds, she says.

“We would look at that [situation] and say, ‘OK, is the family on board? Have the residents met with a physician? We would ask for documentation from the physician that they fully understand [the implications of their decision]. We would have to examine all of that,” Hamilton says. “If we want to honor that [decision], we would do a shared risk agreement, and we would look at [the case] very closely.”

Resident Decision-Making and Advance Directives

Nationwide, every competent individual has the right to refuse life-saving care. In 1990, Congress passed the Patient Self-Determination Act, which requires healthcare providers who get federal Medicaid/Medicare funding to inform all adult patients that they can either accept or refuse medical treatment, and that they have a right to create an advance directive.

Although having an AD isn’t universally required, some administrators may direct residents to create a living will upon entering a senior living community, says Mimi Mahon, PhD, RN, FAAN, a palliative care nurse practitioner who is currently an associate professor at George Mason University’s School of Nursing.

If administrators encounter residents who are unsure of how to frame an advance directive, she recommends suggesting these two questions:

• If you are unable or choose not to participate in decision making, who can/should represent your wishes?
• If you’re unable or choose not to participate in decision making, what about your health do you want us to consider?

In cases where there’s not an AD, Mahon says providers need to ensure that an individual can be deemed competent before allowing them to carry out certain end-of-life wishes.

“For an administrator, the best thing to do is get a consult,” she says. “Find out who the palliative care service is in that area.”

State Regulations and Industry Liability

Generally speaking, how to handle senior living residents’ end-of-life wishes is addressed under individual state laws, says Drew Graham, an Aging Services regulatory and litigation specialist with the Atlanta, Ga.-based Hall, Booth, Smith & Slover, PC law firm.

However, liability often isn’t the biggest concern when it comes to cases like these, where an individual may refuse treatment or stop eating and drinking.

“Most states give immunity or clear guidance to facilities on how to handle [these cases],” says Graham. “Facilities worry about following the rules. It’s a regulatory issue.”

Regulations vary state by state, he continued, and most communities are concerned with making sure they abide by state rules. And he, too, emphasizes the importance of establishing competency, especially in cases where there is no AD.

“Competence is key,” he says, adding that some states require senior care communities to send residents to the hospital in certain circumstances, in the absence of an advanced directive.

Ultimately, if a senior living community wants to avoid assisted suicide, then they need to say in their policy that they won’t allow it, Mahon says.

While competent individuals are legally able to refuse life-saving care, regulations vary state by state for individuals without an advanced directive, so it’s important for administrators to know their state’s rules, and it’s a good idea to have residents create advanced directives. Individual cases may vary, and senior living providers need to walk a fine line between honoring residents’ rights and wishes while at the same time managing risk and liability.

Curious about other aspects of VSED?  Participate in a session on this topic at COMMUNITY 2012, the ALFA conference and expo.  Learn more about the ALFA Conference.

A new report based on 2011 data takes an in-depth look at salaries and benefits for a variety of positions in assisted living communities across the country. The report found an overall increase in salaries for senior living professionals, with some positions seeing a greater increase than others.

The study surveyed over 1,700 for-profit and not-for profit assisted living communities, which provided salary and benefit data on almost 65,000 employees. The report summarizes data on 19 management positions and 27 nursing, dietary, and clerical positions as well as 18 fringe benefits.

 All management professions and most other assisted living professions saw a salary bump in 2011. Chief financial officers saw the highest increase out of all management positions. CFOs received a salary of 122,226 dollars, a 3.9 percent increase over 2010. Marketing directors also saw a large increase in compensation. Although marketing directors only saw a salary increase of 2.05 percent, their average bonus was 9,354 dollars or 20 percent of their annual salary. 2010’s average bonus was only 14.64 percent of that year’s average salary.

The data also revealed an average salary increase of 3.3 percent, to 141,847 dollars, for CEOs and an average salary increase of 2 percent, to 65,251 dollars, for directors of nursing.

To purchase the report: 2011-2012 Assisted Living Salary & Benefits Report, visit the Hospital & Healthcare Compensation Service’s website.

As part of its ongoing series of webinars on hot topics in the bioethics field, Creighton University will host a complimentary webinar titled “No Place for Dying: Hospitals and the Ideology of Rescue.” The webinar will be presented by Helen Stanton Chapple, PhD, RN, MA, CT, a Creighton faculty member who teaches in the online Master of Science in Health Care Ethics program. Chapple is also a past president of the Association for Death Education and Counseling (ADEC) and current chair of the ADEC Credentialing Council.

Chapple will discuss the idea that many end-of-life dilemmas in the United States are a result of conflicts in American ideology rather than a question of ethics. In addition, the proliferation of advanced technology, the respect for choice, and the need to provide equal opportunity for death avoidance has led to a “rescue first, ask questions later” mentality. Yet often there comes a point where clinicians must work to limit suffering and prepare for death. In her research on treatment for the dying, Chapple discovered that clinicians turned to a “ritual of intensification” that allowed seriously ill patients to be moved from “rescuable” to “non-rescuable” status. This process helped medical professionals to navigate potential conflicts and guilt.

“The ritual preserves belief in the project of medicine,” said Chapple. “Clinicians use ritual to separate the living from the dying, and ultimately the dying from ourselves.”

Date, time, and registration information for the webinar are as follows:

TITLE: “No Place for Dying: Hospitals and the Ideology of Rescue.”

DATE: Monday, February 27, 2012

TIME: 6:30 PM CST

Click here to register

The webinar series is designed to inform medical professionals and others who deal with ethical issues in health care about trends and ideas in the field, as well as to promote Creighton’s Master of Science in Health Care Ethics program. Offered in the convenient online format, the online program pulls from such diverse areas as history, culture, philosophy, politics, economics, and law to explore the meaning, history, context, and implications of bioethics. With courses in Health Policy, the Law and Health Care Ethics, Social & Cultural Contexts of Health Care, Theories of Justice, and Public Heath Ethics, students build their awareness and understanding of the meaning, impact, and practical applications of ethics in the real world. Offered through Creighton’s Center for Health Policy and Ethics (CHPE), the program is built upon the University’s core Catholic and Jesuit values of conscience, compassion, and concern for poor and marginalized groups and individuals.

To learn more about upcoming events at Creighton, go to the Upcoming Events page. To learn more about the webinar series, contact Allison Anderson at the phone number or email provided.

About Creighton University

Creighton University, a Catholic, Jesuit institution located in Omaha, Neb., enrolls more than 4,200 undergraduate and 3,500 professional school and graduate students. Nationally recognized for providing a balanced educational experience, the University offers a rigorous academic agenda with a broad range of disciplines, providing undergraduate, graduate and professional degree programs that emphasize educating the whole person: academically, socially and spiritually. Creighton has been a top-ranked Midwestern university in the college edition of US News & World Report magazine for more than 20 years. For more information, visit our website at http://www.creighton.edu.

Yale School of Medicine researchers have found that the likelihood of becoming disabled with age increases with the following factors: having a chronic condition or cognitive impairment; low physical activity; slower gross motor coordination; having poor lower-extremity function; and being hospitalized. Women are also more likely than men to become disabled in their later years.

Based on 12 years of data, the findings are published in the Jan.17 issue of Annals of Internal Medicine by a research team led by Thomas Gill, M.D., the Humana Foundation Professor of Geriatric Medicine and professor of medicine, epidemiology, and public health at Yale School of Medicine.

With age, many people can no longer walk short distances or drive a car, and those with long-term loss of mobility have difficulty regaining independence.

“Losing the ability to walk independently not only leads to a poorer overall quality of life, but prolonged disability leads to higher rates of illness, death, depression and social isolation,” said Gill, who followed a group of 641 people aged 70 or older who could walk a quarter mile unassisted or who were active drivers at the start of the study. All participants could perform essential activities of daily living, such as bathing and dressing.

Gill and his team assessed the participants for changes in potential disability risk factors every 18 months between 1998 and 2008. They also assessed the participants’ mobility each month. Those who said they needed help from another person to walk a quarter mile were considered to be walking disabled. Those who said that they had not driven a car during the past month were considered driving disabled.

On a monthly basis, the research team also assessed the participants’ exposure to potential causes of disability, including illnesses or injuries leading to hospitalization and restricted activity, which increased the likelihood of long-term disability by 6-fold.

The team found that multiple risk factors, together with subsequent illness and injury leading to hospitalization and restricted activity, are associated with an increased likelihood of developing long-term walking and driving disability. The team considered a disability to be long term if it persisted for at least six months.

“We’ve learned that targeted strategies are needed to prevent disability among older people living independently in the community,” said Gill.