Having spent the last few years immersed in reviewing state regulations and reviewing inspection reports of senior living communities, I am familiar with what communities are required by law to have in place so the safety of their residents is ensured. All to often these requirements are advertised as amenities and perks, and each time I see this, I can’t help but shake my head in exasperation. Here are a few of the most commonly listed requirements that I often see senior living communities advertise as amenities or perks when in fact they are required by law.

Sprinklers and Fire Alarm System

When I see this claim on a community’s website – We are fully outfitted with sprinklers and a fire alarm system - I always can’t help thinking, “Of course you should be, that’s the law.” As part of the licensure process, communities are inspected by the local fire marshal to ensure they are in compliance with the state code. Communities are even required to have extra safety measures in place when they care for bedridden or nonambulatory residents. Here’s the language from California’s Manual of Policies and Procedures for Residential Care Facilities for the Elderly  Section 87203 Fire Safety—All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

Granted a residential home doesn’t have sprinkles or a fire alarm system, apart from a smoke alarm, so seniors might not realize that the safety features of sprinklers or a community-wide fire alarm are required. Yet nearly every public space a senior may visit is outfitted with fire protection systems, so why should senior living communities be any different.

Employee Background Checks

Performing employee background checks are advertised as community policy when, yet again, this is a policy required by law; even volunteers are required to have background checks in most states. While reviewing inspection reports, I have seen communities cited for allowing a staff member to work with residents before their background check is completed, and in California this citation is accompanied by a fine.

The state of Wyoming’s Rules for Program Administration of Assisted Living Facilities spells it out quite simply in Section 5c :  All staff of the assisted living facility shall successfully complete, at a minimum, a State of Wyoming Division of Criminal Investigation (DCI) fingerprint background check and a Department of Family Services Central Registry Screening before direct resident contact.

Protecting Resident’s Privacy

Resident records and resident information shall be kept confidential and only provided in accordance with law—as per New Hampshire’s Residential Care and Health Facilities Rules. You can’t get more straightforward or simpler than that. A community is required to protect a resident’s privacy, which can mean locking resident records in a secure office or instructing staff not to discuss a resident’s health status in front of other residents.

So how can families know a community is in compliance with state laws if it’s not specifically called out? During the tour, ask to see the recent health and safety inspections or even procedure manuals. Communities are often required to keep the latest copy of the inspection survey on file or even post it for public viewing. Procedure manuals will detail how a community handles fire drills, background checks and resident privacy. If the community readily answers your questions and demonstrates their compliance by showing you these documents, that’s how you can be satisfied your loved one will be well taken care of—through actions not words.

Welcome Joan’s Journeyers to my July musings. As a senior, considering to move closer to loved ones seems like a no-brainer. What better solution to the inevitability of old age than proximity to the people dearest to us?

Now take a deep breath and reflect upon the question. Moving and living closer to relatives is not a one-way decision; it is a decision that a senior and their adult children, and in most cases, many more folks have input in. Whether moving across town, across counties or across the country, as I did, moving closer to family or significant others is a shared, life-changing experience.

I am one of the fortunate seniors, says Sam Rosenberg, executive director, Holiday Villa East, (HVE), an independent living community in Santa Monica, California. An attorney with 30 years of assisting seniors and their families, Rosenberg has a wealth of knowledge and is a gold mine of anecdotes relating to successful and not-so-successful seniors who move to live closer to dear ones.

Happily, Rosenberg notes that I have the recipe for successful senior living near my family because: 1) I chose to move to senior living, 2) I chose the location after consulting and planning with my family on both coasts, and 3) I chose the senior community where I live.

Learn more about how choosing to move near family involves the entire family and Maslow’s Hierarchy of Needs  in Joan’s Journey, Part 32.

In our final post on long-term care costs (here are our earlier posts on the 2015 costs of independent living, assisted living and Alzheimer’s and dementia care), we tackle the long-term care option that allows seniors in need of supportive services to safely live at home.

Home care is a catch-all term for the non-medical services, such as help with activities of daily living, provided to individuals outside of a care facility. For seniors, these services are intended to allow them to continue residing in the comfort of their own home rather than moving to a senior living community.

Of the long-term care options available, home care can be one of the more inexpensive options, provided that few hours of care are necessary, as it can be customized to fit each person’s situation. For example, if your loved one only needs assistance with meal preparation or housekeeping, you only have to pay for these services. Home care is also charged by the hourly, daily or overnight so you can schedule for how long the caregivers work. How long loved ones will require home care can vary:  some may only need short-term end-of-life care, while for others, it is a temporary measure before they must transition into a assisted living or memory care community once home care becomes cost-prohibitive.

For the past 10 years Genworth has surveyed the costs of long-term care services, including home health aides, adult day care and nursing homes, and issues an annual Cost of Care Survey providing a state-by-state breakdown of what consumers can expect to pay for each type of care. As you would expect, the daily and per-hour rate varies between each state:  North Dakota is the most expensive at $27 per hour while West Virginia and Louisiana are the least expensive at $16.

If you are considering home care for a loved one, we have a helpful state-by-state breakdown of the home health aide daily and per hour rate. And if seeing these costs makes you realize it’s time to create the long-term financial plan, be sure to visit our Senior Finance Center.


Recently, we discussed the benefits of pets for senior citizens. But the benefits of animals—particularly, service dogs—can extend far beyond the companionship and other benefits of sharing your home with a furry, four-legged friend.

What is a service dog? service dogs for seniors

Service dogs are specially trained dogs who provide tremendous benefits to people with physical disabilities, including seniors. Service dogs are probably most recognized for their ability to help individuals with vision impairment navigate their homes and neighborhoods, but they are used to aid people with a variety of disabilities and in a variety of circumstances. Service dogs are even being used to help Veterans cope with Post-Traumatic Stress Disorder (PTSD) and physical limitations resulting from service injuries. Thanks to the Americans with Disabilities Act (ADA), service dogs are permitted in any public place where the general public goes.

Is a service dog right for your aging loved one?

According to Philips Lifeline, service dogs are being used to help the elderly today more than ever before. But how do you know if a service dog is the right choice for an aging loved one?

There are several types of service dogs who can serve seniors, including:

  • Seeing Eye dogs for the visually impaired
  • hearing or signal dogs for the deaf or hearing impaired
  • mobility assistance dogs who can aid with daily tasks, retrieve items, open doors, or even pull a wheelchair when needed

For instance, a service dog can serve as a senior’s eyes for an aging loved one with visual impairment due to glaucoma or any other chronic condition that causes vision loss. A Seeing Eye dog can give your aging loved one confidence and allow her to navigate streets, sidewalks, stairs and other areas safely. A service dog, in this and other cases, gives a senior greater independence by assisting in areas where the senior struggles due to his disability.

Service dogs are even beneficial for seniors who have family caregivers or outside caregiving assistance. When a service dog helps a senior to be more independent and carry out daily tasks without the direct assistance of a caregiver, caregivers have more time to dedicate to tasks that can’t be taken care of by a service dog, such as cooking, cleaning, and running errands.

Where can I find more information about service dogs?

There are several organizations dedicated to training and placing service dogs for individuals with disabilities, offering information on service dog training and ADA laws related to service dogs, and service dog registration.

  • Assistance Dogs International is “a coalition of not for profit assistance dog organizations. The purpose of ADI is to improve the areas of training, placement, and utilization of assistance dogs, staff and volunteer education, as well as educating the public about assistance dogs, and advocating for the legal rights of people with disabilities partnered with assistance dogs.”
  • The National Association of Service Dogs aims ”to help people live a more enjoyable and productive life using service dogs.” The organization was established to register and certify service dogs and created the first formal process requiring documentation to aid in service dog verification.
  • The National Service Animal Registry maintains a service animal database and provides an abundance of resources on service dogs and the rights of service dogs.
  • The United States Service Dog Registry allows you to register a service dog, as well as learn about the laws and regulations that apply to service dogs. This resource also offers a simple service dog lookup directory.

There are also locally based organizations that train service dogs and provide service dog placement with Veterans, seniors and the disabled. If your loved one is a Veteran, one good starting resource is the National Resource Directory, which connects wounded warriors, service members, their caregivers and families with a multitude of resources that provide help, support, and assistance, including service dog organizations. DogCapes.com offers a useful, state-by-state listing of service dog trainers, as well.

Service dogs can literally be lifesavers for seniors and other individuals with disabilities, let alone the tremendous relief and help they can offer a senior in day-to-day activities. If you think your senior loved one could benefit from a service dog, seek out local resources and organizations, or start with the resources listed above and get more information today.

MPIRICA Rating SystemEarlier this year the American Medical Association (AMA) released a list of high-risk surgeries for adults aged 65 and older. Coronary artery bypass grafting (CABG), spleen surgeries, small bowel and related colon procedures were among the surgeries that made the list. So when families have older loved ones who have to undergo such surgeries, how can they find the best hospital for that procedure?

While you could rely on word-of-mouth or top 10 lists of the region, there is now a purely data-driven resource you should bookmark.

MPIRICA is a newcomer to the Seattle startup scene and was inspired by founder and CEO Shakil Haroon’s search for the best local hospital when a family member required surgery. What he didn’t find was a central place where he could research this potentially life- and cost-saving information. Each year magazines, such as Consumer Reports and U.S. News, produce lists ranking the top hospitals around the nation, but what’s missing are outcomes-based, procedure-level ratings for every public hospital nationwide.

To fill this information void, in 2014 Haroon founded MPIRICA with the goal of developing a ratings system. He soon found that such a ratings system required deep MD level expertise. A search for such expertise led him to partner with MPA HealthCare Solutions and the MPIRICA Quality Score was born. MPA HealthCare Solutions, under the leadership of Harvard-trained cardiologist and MPIRICA co-founder Dr. Michael Pine, is responsible for the analysis used to determine the popular Consumer Reports’ top hospitals issue and other healthcare ratings.

MPIRICA ScoringWe created MPIRICA to deliver ratings based purely on the outcomes achieved by hospitals and surgeons, explains Bob Piper, who is responsible for MPIRICA’s business and technology alliances. The source data for the MPIRICA Quality Score is publically available from the Center for Medicare Services. Any hospital that accepts Medicare and Medicaid is required to provide data, such as type of surgery, cost, adverse effects and patient age. These audited results make it a “great source of data,” Piper says, but we do have to scrub and normalize it, which is where Dr. Pine’s expertise and scoring comes in.

Currently 65 in-patient surgeries and nearly 5,000 hospitals are included in the MPIRICA data. Scores range from a low of 100 to a high of 800. A low score represents a significantly higher risk of an adverse outcome.

Piper says that although out-patient surgeries, which are the most common, are currently not scored, over 25,000 surgeon scores are being added. “If a surgeon has a great score for an in-patient procedure such as total knee replacement, you can be confident in their ability to perform related out-patient surgeries, such as ACL reconstruction,” he says. MPIRICA plans to add scores for out-patient procedures by the fall of 2015.

Hospitals you won’t find are those in the Veteran’s Affairs system, and if a surgery hasn’t been performed at a specific hospital enough times to reach critical mass, it won’t be included since statistical significance hasn’t been reached.

MPIRICA Ranking of CABG Surgeries by HospitalOn MPIRICA’s website, consumers can search for a surgery’s MPIRICA Quality Score at hospitals across the nation for free. And when you pair this search with a list, such as the high-risk surgeries for older adults mentioned earlier, families can make more-informed decisions about the quality and cost of surgical treatments.

For example to find the hospitals which are highly rated for CABG, find its ICD9 code on the AMA list and select this same surgery on the MPIRICA website. (On the MPIRICA website, the period is missing, i.e. the AMA list says 36.14 and MPIRICA is 3614.) Then, select the City and State you live and click Search. In the Seattle area, Harrison Memorial Center, Providence St. Peter Hospital and Providence Regional Medical Center all received a score of 620, which is in the top 25 percent of hospitals nationwide.

This July I find myself with lots of things to write about:  thistles, my granddog’s death and a lemon tree. Do they go together, probably not. But it’s summer and I want you to know about them. Also I am recommending Being Mortal by Atul Gawande, a most significant book that I urge everyone, particularly seniors, to read.

Learn more about what’s been keeping me busy this summer in my latest post What’s New at My Place.

This post was written by Margery Fridstein, an author and retired psychotherapist who lives in a CCRC outside of Denver, CO. She is chronicling her experience in the monthly series, “The Last Stop With Margery Fridstein.”

pets benefit the elderly Pets are generally associated with love and happiness, bringing delight to their owners and those who are privy to their goofy antics and loveable snuggles. This is especially true for seniors and a big reason why animals like dogs and cats are used as therapy pets in senior living communities, hospitals, and the like. As PetInsurance.com points out, “Evidence suggests four-legged friends are a real health benefit for elderly people, helping them live longer, healthier and happier lives.” Here are just a few of the many ways animals benefit the elderly.

Pets can lower blood pressure and heart rate

There’s just something calming about petting a four-legged, furry friend, and there’s evidence to prove it: Studies dating back to 1988 have shown a correlation between human-dog interactions, such as talking to and petting a dog, and a lower blood pressure, and the American Heart Association says that owning a pet can help protect you from heart disease.

Lower risk of heart disease linked to other benefits of pet ownership for seniors

There are several reasons for the link between pet ownership or spending time with animals and the lowered risk of heart disease, including the idea that pet owners, particularly dog owners, tend to be more active. After all, dogs need exercise, too, and taking the dog for a daily stroll is good for both the body and the soul.

Cats, too, require regular maintenance, such as grooming, litter box changes, and playtime, all of which contribute to increased activity for the people who care for them. Pet ownership has also been associated with lower stress levels and lower rates of depression. Pets make great listeners, and they’re always happy to see you.

Animals reduce feelings of loneliness and isolation

Seniors living alone can experience feelings of loneliness and isolation, which in turn can lead to depression. Animal companions can help to alleviate these feelings by providing constant companionship and even boosting the self-esteem of an elderly person. Pets rely on their owners to provide food, care and love, which gives seniors a sense of purpose as well as a welcome distraction when seniors are feeling down.

What’s more, seniors tend to take better care of themselves when they have a four-legged friend relying on them for food and affection, according to the nonprofit organization Pets for the Elderly. Because they want to stay healthy enough to provide the care their beloved pets require, seniors are more likely to be compliant with medications, get daily exercise, and eat healthier.

Visits from furry friends in senior living communities have tremendous effects on residents

The incredible bond that exists between humans and animals like cats and dogs and the amazing effects these animals can have on sick and elderly individuals has led to animals being used for therapy in hospitals and senior living communities. Many senior living communities have resident pets, such as a cat or dog who roams the community and provides companionship for both staff and residents. Additionally, there are more senior living communities allowing residents to bring their own pets to the community.

But even without these options, many communities take advantage of animal therapy programs, where local animal shelters bring friendly pets for visits with residents. Likewise, there are animal therapy organizations that train dogs (and sometimes cats) and make regular rounds at hospitals, nursing homes, assisted living communities, and similar settings to provide the benefits of animal companionship to patients and residents. Many a miraculous result has been recorded and attributed to the amazing power of animals to bring out the best in people. One such story is revealed by Everyday Health, in which a cat  visited a terminal man who had slipped into a coma. Miraculously, upon the cat being placed on his bed, the gentleman awoke from his coma and began to pet the cat.

Is pet ownership the right choice for you or your senior loved ones?

It’s clear that humans and animals share an incredible bond. While a pet can have many positive benefits for the elderly, adopting a pet isn’t a decision that should be made lightly. Be sure that you or your elderly loved one are able to provide proper care for a pet, and if you do decide to adopt a pet, take care to choose the right pet. Cats don’t typically require long walks outdoors, for instance, and some dog breeds are more active than others. If you live in a small home or apartment, a small-breed dog or cat may be a better choice than a large-breed dog. These are all considerations that should be weighed when adopting a pet.

If caring for a pet seems out of reach, consider looking into local animal therapy programs where volunteers bring animals for periodic visits—allowing seniors to reap the benefits of companionship without the demands of caring for a pet of their own.

Of the long-term care costs that families may have to budget for, memory care is one of the costliest care types available, second only to nursing homes. The reason for this is often because seniors with Alzheimer’s or dementia require higher levels of care due to the behavioral, emotional or physical changes that this disease leaves in its wake. For this reason, communities often have a separate, secured neighborhood for residents requiring memory care or even specially designed communities which only care for seniors with Alzheimer’s or dementia.They will also advertise that staff are specifically trained in Alzheimer’s care, whether through an company-specific training program or the Alzheimer’s Association’s CARES® Dementia Care training program.

Yet when it comes to finding the costs of much memory care, this pricing information isn’t readily available to families. The annual Genworth Financial Cost of Care Survey doesn’t include the cost of memory care, and while families can use the cost of assisted living as a starting point, the out-of-pocket cost is several thousand dollars more per month. And the actual monthly cost is known only after an assessment is conducted to determine the level of care a future resident will require upon joining the community.

To aid families in budgeting the cost of memory care for a loved one, SeniorHomes.com has compiled a state-by-state comparison. These costs were calculated based upon the pricing which our clients provide to us and what is displayed on a community’s profile. To find the cost of care in your state, visit our recently updated 2015 Memory Care Community Costs:  Facts and Figures.

A casual lunch, a birthday dinner and a visit to the park—these are the priceless moments my family and I have shared since my moving to Holiday Villa East so I could live near my children and grandchildren.

Regrettably, while living on the East Coast, I missed nearly all my Seattle grandchildren’s birthdays, school, sport, extracurricular and special events. Growing up, and as my children grew up, grandparents were our biggest cheerleaders. They were the go-to folks who bought all the unsold Girl Scout cookies and came to EVERY, even remotely-related event.

Since my children left for college decades ago, I’ve yearned for a grandchildren-grandparent connection. It’s been my dream; granted it’s not a magnanimous dream like that of renowned civil rights activist, Martin Luther King. My dream, Joan’s Dream, was to spend Mother’s Day and my birthday each year with at least one of my children. By moving across coasts, from the Atlantic Ocean to the Pacific Ocean, from Baltimore to Santa Monica, my dream has come true.

I am celebrating 18 months at Holiday Villa East, a senior living community in midtown Santa Monica, California. I live minutes from the city’s world-famous beaches, restaurants, shops and activities. When I open the sliding doors to my apartment, the ocean breeze fills my unit and generally keeps the temperatures moderate. The dream-fulfilling topping on this cake is that I have easy transportation to the home of my son Mark, daughter-in-law Lindsay, and grandchildren Oliver, 5, and Madeline, 2.

Since arriving at Holiday Villa East in February 2014, I have attended two years of endearing and entertaining birthday parties for Oliver and Madeline, two years of Oliver’s amazing piano recital performances, and his heart-melting preschool graduation. Sharing in these grandchildren milestones is monumental after living across the country.

Importantly, in order to share holidays and special occasions as a family, we are able to coordinate Los Angeles, San Francisco and Seattle locations with my other two children. Santa Monica is conveniently located not far from Los Angeles International Airport (LAX). Happily, my son Brian and three grandchildren, Natasha, 17, Stella, 14, and Geoffrey, 10, visit two or more times a year. Likewise, my daughter Allison and her friend Randy visit from San Francisco on weekends and special occasions. I am blessed. Joan’s Dream has come true.

Whether one moves across the coasts as I did, or across town, relocation is a huge, life-changing event. In late July, Joan’s Journey will explore the realistic and unreasonable expectations of moving close to family, and a suggested success plan. In the Comment Section below, SeniorHomes.com and I invite you to share your relocation experiences with us. Until the next Joan’s Journey, enjoy the trip day by day.

Joan London is a freelance medical and social service writer who specializes in topics on aging. London moved from Maryland to California to enjoy life in a senior living community and enhance her quality of life by living closer to her children and grandchildren.

Benefits of Swimming for SeniorsEverywhere you look, it seems someone is touting the benefits of physical activity for seniors. Maintaining physical fitness and overall health means improved balance, better management of chronic disease, such as diabetes, improved cardiovascular health (which in turn lessens the chance of cardiovascular disease), and many other benefits that contribute to well-being as we grow older. Regular exercise can even help you sleep better, reduce stress and anxiety, and, of course, help to promote healthy weight management.

But aging, over time, contributes to a loss of muscle tone, painful joints, and other effects that make exercising a not-so-pleasant experience for some older adults. While plenty of exercises offer modifications that make the activity more bearable for people with physical limitations, swimming, in particular, is ideal for older adults. Here’s a look at the benefits of swimming, water aerobics and aquatic therapy for seniors.

Swimming is Easy on the Joints

One of the most common complaints from older adults is aching joints, due to arthritis or even normal wear and tear from years of high-impact activities, whether on the job or through recreational activities. High-impact exercise consists of activities such as running, jogging, and plyometrics—activities that involve your body (your feet, particularly) repeatedly coming into contact with the ground. These types of activities are quite stressful on the joints, which can contribute to increased aches and pains both now and in the future.

Swimming, on the other hand, is a low-impact exercise. Note that impact and intensity are not the same thing, meaning you can get just as much of a workout and reap the same benefits from low-impact activities; it’s just a different type of movement. When you swim or participate in water aerobics, your body weight is partially supported by the water, so there’s less weight and strain on your ankles, knees, hips and back.

Swimming Can Lead to Increased Flexibility

Many seniors are able to gain flexibility and increase their range of motion while exercising in the water, thanks in part to the buoyancy effect of water, which supports some of the body’s weight. The motions you make while swimming not only increase muscle strength and tone, but lengthens your muscles and limbs in a similar fashion to yoga.

Swimming Improves Quality of Life 

For many people, there’s just something calming and relaxing about water. Spending time in the pool, lake, or pond isn’t only good for your body; it offers mental health benefits as well, such as reducing stress and anxiety. The Centers for Disease Control and Prevention (CDC) states, “Water-based exercise improves mental health. Swimming can improve mood in both men and women. For people with fibromyalgia, it can decrease anxiety and exercise therapy in warm water can decrease depression and improve mood.”

Additionally, swimming offers benefits for pregnant mothers and their unborn children, as well as social and familial benefits for children with developmental disabilities. In other words, swimming is a social activity with built-in health benefits, and an activity seniors can participate in with their children, grandchildren, and other family and friends, with benefits for all.

Swimming Offers Benefits for Bone Health

Any physical activity, particularly weight-bearing exercises, will help to improve bone density and bone strength, an important consideration for older adults. Post-menopausal women, in particular, have an increased risk of developing osteoporosis.

“After the age of 50, a third of women and a fifth of men experience a fracture because of osteoporosis, or chronic reduction in bone quality and density. While bone density naturally decreases with age, the risk of osteoporosis is lowest among those who exercise regularly. By swimming, seniors can better preserve bone density and fight osteoporosis,” according to the National Swimming Pool Foundation.

Swimming Offers Cardio and Strength Training in One

Swimming will raise your heart rate, offering cardiovascular benefits by increasing blood flow, boosting your metabolism, and increasing your energy. And because water offers some resistance while you move your body through it, whether you’re taking a traditional or leisurely swim or participating in organized water aerobics, you’re getting strength training benefits at the same time. This will help to improve muscle tone and overall strength and balance, reducing your risk of falls as you age and boosting your cardiovascular and respiratory health.

Of course, it’s always wise to talk with your doctor before beginning any new exercise program or physical activity to make sure you don’t have any underlying health concerns that would pose a risk. But for many seniors, swimming is a fun and social activity offering both physical and mental health benefits.