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Popular industry publications have highlighted the disagreement among key executives’ outlooks on senior housing development. A recent article in Senior Housing News titled “Why a ‘Dumb Money’ Influx Has Senior Housing Execs Jittery” speculates that owners and operators are worried about rogue developers with no experience in the business coming in.


Conversely, Senior Housing Business published conclusions from an expert panel at the Assisted Living Federation of America 2015 Senior Living Executive Conference in Tampa, FL, which emphasized the intelligence of lenders/investors and poked holes in the notion that the industry may be on the brink of a bubble.


We sat down with one of our seasoned experts, Jeffery Sands (JS), to gain HJ Sims’ perspective on the news and its potential implications for the sector.


 


Q: How is Sims involved in development right now?


JS: On the nonprofit side, we are providing both tax-exempt bonds and bank financing to fund new developments. Our for-profit team has been focused primarily on creating flexible subordinate debt and/or preferred equity structures. Thus, we are seeing development from both a senior and subordinate lender and equity point of view.


 


Q: In your opinion, what is the reason behind the extremely active development we are seeing?


JS: We see 2 reasons. The industry went through a period of time from 2008 to 2012 when there was very little construction activity. This created a shortfall in supply, which is evident by relatively low penetration rates and high occupancies in many markets. Also, we are seeing very high valuations in acquisitions, so it makes more sense to build rather than to buy to expand.


 


Q: Do you think ‘dumb money’ is playing a part in the development boom?


JS: No, we think that, for the most part, those providing construction financing are not just throwing money at deals. Wall Street and foreign banks, which had much to do with the “bubbles” we saw in the early and mid-2000’s, are not players this time around.


The major sources of construction financing are domestic banks and REITs. The domestic banks are subject to new banking rules that restrict their ability to make speculative or high leverage loans. REITs have been very selective in the development deals they have funded. Further, most lenders are requiring recourse, or personal guarantees, which can take the underfunded developers out of play.


Perhaps there will be some ‘dumb money’, but, on balance, lenders and investors are smarter than ever, and these strict underwriting standards will continue to prevent a bubble in the near term.


 


Q: If you are not worried about ‘dumb money’, what does keep you up at night?


JS: Our main worry is whether the industry will have access to enough manpower or experienced employees to meet the increasing demand. The challenge is in obtaining both the executive and departmental level talent to run operations.


This labor force includes not only executive directors and marketers, but also, and very importantly, housekeepers, caregivers, food service providers, etc. On the professional level, the challenge for the industry will be to continue to spark interest in the field among young people, create training programs and enhance the employee experience.


When it comes to less skilled employees, the industry shares many of the same issues plaguing other service industries such as increases in minimum wage, new insurance mandates, immigration reform, and accessibility.


This article was reprinted with permission from HJ Sims.

With the omnibus spending bill for 2016 not yet finalized, Congress will have to pass a short-term continuing appropriations measure to keep the federal government in operation beyond the Dec. 11 expiration of the present continuing resolution.

The programs affected by the present spending impasse are senior housing and home- and community-based services financed under the Older Americans Act. Medicare and Medicaid are not subject to the annual appropriations process.

Since spending levels for the various federal programs have not yet been finalized, it is still timely to advocate for increases in funding for housing and home- and community-based services. Congress passed legislation in October that enlarged the total funding available for this category of federal programs.

“IRS exams don’t happen terribly often, but when they do, they will change your life,” warned David Trimner, a principal in nonprofit tax with CliftonLarsonAllen, It was just one of the insights, cautions, and lessons captured in the video CLA Talks: IRS Examinations of Nonprofits — War Stories and Lessons Learned.

In this 7 minute clip, Trimner says there are predictable patterns to IRS exams, and that the IRS tends to look at the same types of issues in all of the examinations it conducts. He elaborates on a few of these risk areas, including:

 

  • Executive compensation.
  • Independent contractors.
  • The distinction between advertising and sponsorship acknowledgements.
  • The tax consequences of affinity contracts.

 

It should be noted that The Trade Act, passed June 29, 2015, increased the penalties for some issues discussed in this video. It applies to information returns filed after December 31, 2015.

An IRS examination can drain time and resources, damage morale, and have an adverse effect on the public perception of any organization, Trimner says. He suggests the best way to prepare for an IRS audit is through day-to-day management, governance, and reporting practices.

 

See the video, made available with permission from CliftonLarsonAllen. 

For the last several months, we have advocated for Congress to lift the spending caps that threatened severe cuts in housing and home- and community-based services. Late last month Congress passed a budget measure to do just that.

But we still have to make sure that senior housing and services get the fair share of extra money this new budget allows.

This Is How You Can Help:

Contact your lawmakers and tell them it is crucial that essential services for the aging get appropriations increases.

Talking Points

  • Sufficient funding is needed to cover the cost of renewing all existing rental assistance subsidy contracts for senior housing, including vouchers and project-based Section 8, project-based rental assistance (PRAC) under Section 202, and senior preservation rental assistance (SPRAC).
  • Full funding for the annual contracts is necessary in order to maintain the existing housing stock and prevent displacement of seniors or put scarce housing at risk.
  • These programs affect over 100,000 senior households. The typical Section 202 resident has an income of less than $11,000 per year, and needs assistance with housing and services in order to safely age in place.
  • The Section 202 PRAC projects operate on a very narrow margin. Nonprofits provide quality, affordable housing where seniors can receive the services they need.
  • Provide additional funding for home- and community-based services programs under the Older Americans Act. These services include congregate and home-delivered meals, chronic disease self-management, transportation, falls prevention and other cost-effective services that enable seniors to live independently in their communities.
  • Include adequate funding for the Social Services Block Grant that states use to serve seniors.

Your voice is important.   Take Action NOW!

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Section
701 of the Bipartisan Budget Act of 2015 signed into law by President Obama on
Nov. 2 calls for the Occupational Safety and Health Administration (OSHA) to
increase civil penalties up to 150% in 2016.

The increase is the first to occur since 1999. Increases will be calculated based on changes
to the Consumer Price Index (CPI) between 1990 and 2015 and will be capped at
150%, though analysts do not expect most penalties to reach the cap.

Rulemaking is expected to effectuate the
increases.

Paycheck to Paycheck is comprised of an online, interactive database and accompanying report prepared by the Center for Housing Policy, the research  division of the National Housing Conference, that compares wages for selected occupations with the income needed to buy or rent a home.

The purpose of the database is to examine how full-time workers fare in housing markets around the country. Some of these occupations profiled in the community at large mirror positions held by LeadingAge member employees in senior settings, and LeadingAge continues to promote employer attention to workforce concerns.

Click the links below to view the 2015 report, see the methodology and frequently asked questions or to proceed directly to the database.  

 

A bipartisan budget deal reached by the White House and the U.S. congressional leadership could allow for more funding for senior housing than was provided in the 2016 spending bill the House passed earlier this year. The budget deal also could enhance funding for home- and community-based services provided under the Older Americans Act.

Congress had reached an impasse on spending bills for fiscal 2016, with spending caps legislated several years ago allowing for insufficient funding for essential government operations. Congress also needed to raise the statutory limit on federal borrowing. In addition, almost a third of Medicare beneficiaries faced steep increases in premiums next year because of a quirk in the Social Security law.

The budget deal addresses all of these issues by raising spending caps for both defense and non-defense programs like senior housing and the Older Americans Act. It raises the debt limit through March, 2017. And it provides relief for Medicare beneficiaries against extraordinary increases in premiums.

The agreement does extend Medicare sequestration on provider payments for another year. However, on the whole the budget deal is a positive one for aging services providers.

Once the House and Senate pass the measure, specific legislation will have to be developed to implement the higher spending totals the deal allows. We will continue advocating to make sure that some of the additional funding goes to Section 202 housing, which was woefully underfunded under the appropriations bill the House passed earlier this year.

Much has been written about the Age Wave, where increasing life expectancy coupled with the millions of Baby Boomers reaching older age is creating an unprecedented demographic shift. 

As a result, we need to find ways to care for loved ones, meeting their needs for medical care, financial security, safe housing, reliable transportation, and community?involvement. Some?efforts underway to serve today’s elders hold hope and promise for the generations to come.

In her new book, The Age of Dignity: Preparing for the Elder Boom in a Changing America, MacArthur Fellow (often referred to as the “genius” award) Ai-jen Poo describes the challenges America faces. Ai-jen, whose career started when she began organizing domestic workers in New York City, feels that the issues facing older adults, their families, and paid caregivers offer an opportunity to re-imagine old age and to develop programs that will “potentially bring us together as a nation.”

“We have yet to come up with a plan to support families that are grappling with this question [of elder care],” she said in an email. “And we are at a point as a nation where we cannot afford not to have a plan...I truly believe that this moment of demographic change in our families is an opportunity to develop the bold solutions we know we need to support 21st-century American families.”

Older adults often express their desire to age in place, and to remain in their homes and communities. Doing so can present a few challenges, especially for people who live in large, rambling suburban homes, complete with many flights of stairs and with no access to public transportation. 

The Village Movement, which began as a grassroots effort for elders to help one another, has grown into a national peer-to-peer network. In “Villages,” older residents volunteer to help one another with tasks and chores such as minor home repairs and transportation to physician appointments.

As these networks evolved, they hired paid staff to help members navigate care and services in the community. 

Today, members pay a modest annual fee, and, while they are able, volunteer in the community. There are now some 150 Villages operating in the United States, Australia, and New Zealand, with another 120 under development. They share ideas and information through the Village to Village Network, which helps groups organize, establish, and manage Villages.

Another promising strategy can be found in similar models that enable volunteers to receive credits for the time they serve. When necessary, they can redeem those credits to request services. One such program is Partners in Care, a private non-profit that operates in the exurbs of Washington, DC.

Founded 22 years ago, Partners has some 2,500 members who volunteer “time, gifts, and talents” to assist each other in meaningful ways, and to stay engaged members?of their own communities. New members participate in an orientation program in which they list their skills and interests and what they are able to share. 

A coordinator then matches member requests. (In one instance, a member was tapped to share expertise in Russian.) For the most part, however, volunteers?offer to provide companionship, transportation, and small home repairs and maintenance.

A similar program operates in Japan, where 25% of the population are elders. Ai-jen explains that the Japanese earn an alternative currency called the Fureai Kippu, or “caring relationship tickets,” which, Ai-jen writes, “allow neighbors to care for neighbors, bank that time, and receive support for their relatives on the other side of the country, or for themselves if they need it later on.” A pilot project based on this idea is being tested in New York City.

In the 1970s, a group based in California developed a novel approach to home-based care called Programs for All-Inclusive Care of the Elderly (PACE). 

Today, more than 100 programs are offered in 32 states. To be eligible, a person must be 55 or older and need a level of care provided by a nursing home. Through contracts with community-based organizations, PACE programs offer the health and supportive services people need to remain in their own homes and communities.

Ai-jen Poo’s vision for an Age of Dignity sounds deceptively simple: “We would have policies and supports that ensure dignity and independence for Americans of all ages and circumstances, whether you’re a caregiver, an aging American, a home care worker, or a person with a disability.” Building that system, however, will take a great deal of ingenuity, innovation, and invention. 

To do that means starting now, with what we have and where we are, to build a future where we can all live and thrive.

This article was written by Janice Shuster, the lead writer at Magellan Health in Washington, DC, and appeared in PS Magazine, published by PS Lifestyle. The article is used with permission.

With our aging population, more attention is being given to the importance of spirituality and the overall well-being of seniors.

Many scientists have concluded that religion and spirituality share a “sacred core,” but distinguish the two by suggesting that spirituality is more personal and emotionally experienced whereby religion tends to be taught and involves more organized behaviors.

Spirituality is defined in a very inclusive manner. Unlike religion, which tends to be defined by an institution or formal doctrine, the concept of spirituality embraces the notion of a deep connection to something bigger than oneself. 

It is often described as a way of loving and relating to others with integrity and compassion, and tied to the concept of meaning and purpose in life.

The spirit is traditionally believed to be that vital force within living beings that gives us vigor and energy, and provides us with a sense of determination and courage. It can come from organized religious beliefs, a spiritual connection, and a focus of energy and attention on the present (mindfulness).

Research has shown that those who view themselves as spiritual or hold a religious belief system tend to live more fully in the present, are more creative, and cope better with adversity.

While the search for purpose and meaning in life has plagued people for centuries, aging makes us more acutely aware of this struggle and leads us down a path of resolution. The process of this resolution can either leave us feeling exhilarated and renewed at the realization of meaning, or empty at the inability to find meaning or purpose. 

Think about some of the language that we use when we talk about purpose in our lives. We may refer to it as “something missing.” While we may not be able to put a label on what is missing, we are keenly aware of an incomplete feeling. This feeling can be triggered when confronting a life changing event, an illness, or simply getting older.

The majority of people over the age of 65 report that they rely on religious beliefs to cope. Seniors with a strong spiritual belief system tend to experience less depression, are more actively engaged in life, recover faster from illness and surgeries, and tend to have a stronger immune system.

Strategize to Improve Your Spirituality 

 

  • Practice Meditation. Mindful meditation has been shown to alter the chemistry of the brain by releasing the relaxation response. Just fifteen minutes a day of mindful meditation can reduce stress and significantly improve cardiovascular health, immune function, and mental acuity. Many senior facilities have begun to offer yoga and meditation classes for their residents to improve overall well-being.

  • Become Focused on Others. A dimension of spirituality is the feeling of connectedness to others -- the willingness to do more for others than for yourself. Connectedness decreases loneliness, and improves our sense of meaning and purpose, resulting in a reduced likelihood for depression and physical illness. When senior housing facilities extend themselves to charitable organizations, residents tend to become more engaged and socially connected.

 

This article was written by Dr. Lori Stevic-Rust and appeared in PS Magazine, published by PS Lifestyle. The article is used with permission.

Recent research points to the usefulness of mindfulness practices, such as yoga and meditation, in reducing some of the symptoms of diseases such as diabetes and depression. But for those who are not familiar with yoga, trying it might seem intimidating. 

This ancient practice, with its popular images of sitting cross-legged on the floor and doing a down-dog pose, might appear to require more shape-shifting than older bodies can perform. In fact, yoga can be adapted to accommodate every body: even the stiffest joints and out-of- shape cardiovascular systems can benefit from gentle versions.

According to Carol Krucoff, a yoga therapist at Duke Integrative Medicine, “A growing body of evidence indicates that yoga can be helpful for managing age-related ailments, especially hypertension. There is some evidence for yoga as a therapeutic intervention for back pain, and emerging evidence suggests that it can be useful for people living with cancer, heart disease, chronic pain, depression, and anxiety.”

Ms. Krucoff cited statistics that indicate that most older adults are not getting the recommended 30 minutes of moderate activity each day. This deconditioning can contribute to one of the problems older adults fear most: falling. Yoga can improve practitioners’ balance, and overcome the “wobbliness” that sometimes comes from advanced age, medication side effects, and other risks.

Ms. Krucoff explained that learning to control the breath is a great first step for those interested in giving yoga a try. The breath, she said, “is the only physiologic function that is under voluntary and involuntary control. You don’t have to think to breathe, but if you can voluntarily slow and deepen your breath, it gives you a doorway to the central nervous system. Yogis say that if you control the breath, you control the mind.”

Sally Craig, who offers “Yoga for Creaky Bodies” classes in the Washington, DC, area, began teaching yoga when she was 63. At 71, she credits yoga with her own experience of healthy aging.

“My joints and health are sound, I don’t take medications of any kind,” she said. In studying to become a teacher, Ms. Craig focused on safety for older students, particularly in preventing injuries or moves that could make people feel worse.

Ms. Craig recommends 2 very simple breathing techniques. 

First, she said, inhale very deeply “into the belly” to a count of 4, and then exhale to a count of 4. Try this ten times. Next, she said, take a moment to “notice how you feel, and if you feel different. Do you feel calmer? More relaxed? If the 4-count is too hard, shorten it.”

In addition to learning to breathe as a way to calm the mind, yoga stretches can help strengthen muscles and joints and improve range of motion. It also improves flexibility, which can help to counter the stiffness that often comes with aging. For a simple stretch, Ms. Craig suggested a seated stretch.

“Turn very gently to the right and left while seated in a chair -- don’t lean back into it, but sit near the front. Take your left hand to the outside of the right thigh and look over your right shoulder. Hold this to a count of ten.” 

Repeat this with the right hand to the left thigh. She also recommends a leg and arm lift: seated in a chair, lift 1 leg and the opposite arm straight in front of you for a count of 10.

Finally, Ms. Craig said, reach behind and tuck your fingertips under your bottom, then smooth the shoulder blades to relax them. These very basic and easy moves can be the beginning of a new activity.

With so many types of yoga being taught around the country, it can be hard for a novice to know where to start. Ms. Krucoff recommends working with an experienced and qualified teacher, but notes, “If you can breathe, you can practice yoga.” 

In fact, she has developed a CD that includes gentle yoga exercises for elders, and offers free downloadable relaxation and breathing practices on her website.

“Yoga is something you can do for yourself. You don’t have to go to someone,” she said.

Yoga also offers a mindfulness practice, something more and more doctors are recommending to their patients. Ms. Krucoff said, “To practice yoga you must be present in your mind and body. The practice involves getting into a comfortable, compassionate, non-judgmental, and loving relationship with the self. By being in this moment, yoga brings us back to this sensation.”

Ms. Craig said, “Yoga can help you feel at ease in your body, and not like its prisoner. Many older people feel disconnected from their bodies, and yoga lets you become an ally of your body.”

To try some of Ms. Krucoff’s free lessons, visit her website: www.healingmoves.com.

This article was written by Janice Lynch Schuster, the lead writer at Magellan Health in Washington, DC, and an author of Handbook for Mortals: Guidance for People Facing Serious Illness. The article appeared in PS Magazine, published by PS Lifestyle. The article is used with permission.

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