Finding a Home Between Assistance, Independence

By Jeff Raymond, The Oklahoman

Oct. 8–BROKEN ARROW — Almost three decades ago, when Franciscan Villa began to admit laypeople alongside the Sisters of the Sorrowful Mother who lived there, nothing but fields, woods and cows were nearby.

Now, the stately convent next door is empty and the campus sits amid a residential construction boom a few miles from a Bass Pro Shops store. As the area around the assisted-living center and nursing home has changed, so has the state’s environment for caring for the elderly.

“It’s kind of an evolving industry, to tell you the truth,” said Dorya Huser, who oversees long-term care for the state Health Department.

The 15 nuns who live in a wing at Franciscan Villa, which has 79 assisted-living apartments and 80 nursing home and Alzheimer’s beds, remain an important part of life there.

Another thing that hasn’t changed is Franciscan Villa’s mission. It was intended to be an affordable place for the elderly, and it is — at least by the standards of its competitors, where rooms may resemble posh hotels and annual costs can reach $50,000.

Franciscan Villa charges about $1,670 a month for an assisted-living studio apartment and associated services such as meals and basic nursing care.

“For those who are looking, you won’t find a more affordable place,” administrator Ron Hoffman said. “We’re not so concerned about how fancy we are, but we want to do it right,” he said.

Tulsa-based St. John Health System’s senior living portfolio includes Franciscan Villa, Frances Streitel Villas in Collinsville, Heartsworth House in Vinita, and senior apartments and long-term nursing care elsewhere.

A changing environment Assisted living in Oklahoma has evolved from residential care programs that offered rooms and medicine assistance to programs that offer a seamless transition from independent-living apartments to assisted living to nursing home care at the same location.

“It’s going to do nothing but grow even more,” said Mary Brinkley, executive director of the Oklahoma Association of Homes and Services for the Aging.

Hoffman compared the industry to the banking industry. “People expect more service,” he said.

About 6,000 Oklahomans are in assisted-living programs. Statewide, there are 127 such programs, 12 of which offer levels of care, according to the state Health Department.

Although programs may set admission criteria to qualify for assisted living, residents typically must be mobile and not require 24-hour care. Anything more, and they are better cared for in nursing homes.

Franciscan Villa provides meals, security, around-the-clock access to nurses and activities.

“One of the state’s newest and nicest such programs is Tulsa’s Montereau in Warren Woods, a nearly $100 million hilltop complex. The Rev. Henry B. Spielmann, 95, moved into Montereau’s assisted-living unit in May.

Spielmann, a Catholic priest who taught and worked for more than a half-century at Tulsa’s Cascia Hall Preparatory School where he lived in a monastery, appreciates his apartment and the treatment he has received.

“They look after your medical needs. They check on you every night,” he said.

As Spielmann’s heart troubles worsened, he needed attention he couldn’t receive at the monastery, where residents live independently.

James Joslin, who oversees long-term care licensure for the state Health Department, said assisted living is struggling to figure out the appropriate level of care to provide before moving residents to more intensive environments.

One “hot issue,” he said, is building permits. As people live longer and assisted-living programs want to keep them, whether construction meets the fire code can become problematic.

“Is the building designed for residents who can’t evacuate?” he said, noting that many were not built to house nonmobile residents. A law that passed last year allows assisted-living programs to keep some residents who would otherwise be moved to nursing .

Huser said complaints have increased slightly.

“I believe that what we are finding that’s of concern to us is medical issues. That is sort of the source of our concern at this point in time,” she said, explaining that family members may not understand that nurse oversight often isn’t 24-7.

“It becomes a real head-scratcher: How do you provide quality care for very cognitively impaired seniors in an assisted living environment?” said Richard Woodard, president and chief executive of Oklahoma City’s 400-resident Epworth Villa, which offers independent living, assisted living and nursing home care.

At Epworth Villa, residents at one time lived in assisted living for 19 to 20 months.

Now, the average stay has climbed to two years. Woodard said wellness programs and a focus on nutrition and helping residents maintain their independence were part of the reason.

In 1990, the average person coming in was 77 years old; now the average age at admission is 84.

“There’s no question that people … are waiting longer to make that decision,” he said.

Why they go Hoffman said seniors seldom welcomed the idea of leaving their homes, belongings and, partly, their independence. Typically, their children make the first call because of their parents’ declining awareness or slow recovery from a medical procedure.

“More times than not I’m surprised to see how well they adjust,” he said of moving to places such as Franciscan Villa.

Brinkley said assisted living was a step between independent living and nursing home care, one that many people don’t take advantage of soon enough, instead waiting until they’re so far along they need around-the-clock nursing care.

When a person enters, even when they need no assistance, “When you need help, it’s available,” she said, describing the “snowball” effect of declining health and awareness. “Assisted living is a homelike environment where people can have quality of life and social engagement” and have their needs met, she said.

“It’s a fabulous lifestyle for those that have financially prepared for it,” she said.

Woodard said Epworth Villa, which opened in 1990, has two levels of assisted living and two levels of nursing care. Although it is private-pay, it continues to care for long-term residents who run out of money.

“It really is saying that the not-for-profit has had a commitment for providing care for seniors for many years,” he said.

Epworth Villa is affiliated with the United Methodist Church.

Paying for it Neither Medicare nor Medicaid pays for assisted living, so residents are forced to live off their investments or hope their Social Security checks cover the costs.

Although Medicaid waivers exist in many states to pay for some assisted living care, Oklahoma is not one of them.

Jo Kilgore, spokeswoman for the Oklahoma Health Care Authority, which administers the Medicaid program in the state, said many people are confused about what Medicaid can cover.

“We would not be able to pay the entire cost as we do for nursing facilities,” she said.

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Copyright (c) 2007, The Oklahoman

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