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Assisted living options grow in Butler County, though needs remain

Hamilton Journal News - 2/1/2020

Feb. 1--There aren't enough older adults who can afford to live at all the newly built assisted living homes in the area.

An expert at Miami University said occupancy was down from 89% to 86% in 2017, according to the latest assisted living census.

Bob Applebaum, director of the Ohio Long-Term Care Research Project with the Scripps Gerontology Center, who conducts the census, said there are plenty of older adults who could benefit from living in an assisted living facility and getting help with daily tasks like cooking and medication management.

However, the costs are higher than most people can pay in cash, and only a small portion of the beds in the region are available to people covered by Medicaid.

"It's what I call the 'not enough rich old people' problem," Applebaum said.

Assisted living facilities are mostly a cash-pay service, though there is a program that about 4,000 to 5,000 Ohioans use that allows people covered by Medicaid to receive a waiver to pay for assisted living services. Otherwise a unit can cost about $4,000 or more per month.

Hundreds of new assisted living units have been built in the region in recent years, catering to the growing population of seniors who want housing where they can also get help with daily activities.

The services at assisted living facilities can vary significantly between locations but generally include meals, housekeeping, social events, help with medication and help with personal care.

The population has been aging, and that's been increasing demand for these facilities -- there will be a projected increase of 3.2 million people in the U.S. over age 80 between 2017 and 2025. Assisted living facilities have also been attracting people who years ago would have lived in a nursing home.

One of these recent assisted living projects in the area was Chesterwood Village's addition of 26 units, which gives the West Chester Twp. facility 81 units altogether for its Ashley Place Assisted Living area and its Chelsey Place Memory Care area.

In November, Warren County approved a 10-year, 50% tax abatement for the planned Traditions of Lebanon, which will have 142-unit assisted living complex, including 30 units for memory care. The project is planned just south of the Franklin Road-Ohio 123 intersection with Neil Armstrong Way.

In 1993, when Applebaum said the team started tracking residential care facility beds, there were fewer than 10,000 beds in Ohio. While there's not an official designation for assisted living in Ohio, most of the "residential care facility" beds are assisted living. Now there are more than 55,000 beds. That's a faster growth rate than Ohio's population, which went from 11 million to 11.7 million along that same timeframe.


Medicaid pays less for assisted living services than the faciltiies can charge cash paying residents, which Applebaum said is one factor to understanding supply and demand.

"The amount of money we're paying for the Medicaid wavier for assisted living has been pretty much flat since the waiver was passed in 2007," he said.

In the region, there there's a waiting list for people the Area Agency On Aging is working with who want to use Medicaid at an assisted living. Communities often make allowances for long time assited living residents who run out their savings, but the facilities don't always have beds open for new people with Medicaid to move in.

"Probably the toughest person to get into assisted living on Medicaid is an individual who is moving from a community setting to assisted living," Doug McGarry, the agency's executive director, said.

Pete Van Runkle, CEO of the Ohio Assisted Living Association, said assisted living facilities limit or don't accept Medicaid because the pay is too low, though the state is proposing a 3.2% increase.

"If they take waiver at all, which many don't, they tend to limit the number of people they will take," Van Runkle said.

Shannon Burton, marketing adminstrator with Tapestry Senior Living, which opened in July in Springboro, is unique in the area because it was funded with the Low-Income Housing Tax Credit program, which funds affordable housing.

Because of the program, the 118-unit building rents based on income and Burton said staff meet with patients to see if there are extra benefits they qualify for, such as if they are a veteran. They also accept the Medicaid waiver for about 25 of the apartments.

About 40 residents have moved in and 17 more are planning to.

She said she would advise people ask a facility if it takes the Medicaid waiver if it can guaratnee i will accept the waiver or if the resident could be waitlisted.

"You're going to want to ask more questions," Burton said.

Location, location, location

There's also the matter of where the facilities are concentrated.

"Everyone that wants to build assisted living wants to build it in fancy neighborhoods. Nobody wants to really build it in less affluent areas," Applebaum said.

There's affordable housing programs, but he said people who qualify for assisted living don't just need an low rent apartment but also need some assistance with daily living activities.

McGarry said the supply of new assisted living facilities also raises questions about the supply of workers for these facilities.

"As new facilities come on are they bringing newly trained workers to the field or are they expecting to recruit workers that are currently employed elsewhere and to what impact?" he said.

McGarry said some of the locations where these are in demand and being built, such as the outer suburbs, are not places can be hard for workers to get to, especially lower wage workers taking public transportation.

"Workers in long-term care to be primarily female, have transportation limitations and tend to live in less affluent areas. So when you open in a more affluent area, immediately there's concern of how does the worker get there?'" McGarry said.


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