Friday, August 31, 2007

A little fun for Friday (Swinging Seniors)

Eric Christianson from the Waterford Retirement Community in Vancouver, Washington, sent me his most recent newsletter. Here's my favorite part...and a great way to end the week!

Eric says that these two women are part of their community's walking group who go out every week for a walk - and a swing!

Thanks for sharing this, Eric. Helps me remember the most important fact of all: it's possible to live healthy, joyful lives to the very end of our lives. Swinging with friends who share our interests doesn't hurt, either!

Thursday, August 30, 2007

Moving to Home - Let's start with two words

Several news items caught my attention today:

  1. The Canadian government announced a $700 million dollar investment in developing a nation-wide "Aging at Home" strategy: "aging at home is much less costly than long-term care and helps preserve a senior's dignity," says Health Minister George Smitherman.

  2. A news story out of San Antonio that describes a new senior living community that "breaks the mold of the institutional and moves to the residential," says Carlos Moreno, an architect at Marmon Mok LLP, who is designing the community. In addition to being designed like a traditional small apartment, the doors are wide enough to accommodate walkers and wheelchairs, the outlets are higher and all the units are fully wired for computers. The community also offers courses and programs for the community at large, bridging the gap between a senior residence and the rest of the community. Administrator Steve Fuller comments, "They [residents] want to stay connected with the broader community."

  3. Then there's Aging Maven who titled her blog "The Great Diaspora: Moving Seniors" and shared how, at one location in her city condo developer were courting seniors while at another neighbors were protesting a new assisted living project..."You’d think we were talking about sex offenders."

What's going on here is a discussion about "home" and what that means - a discussion that will only intensify as more and more of us become seniors.

I won't want to live in a big house by myself, counting the minutes until my mailman comes by (he'll be the only other human I'll see all day).

I'll want to find a vibrant community of people I can share meals with, take a walk with, discuss the news with. Maybe I'll forget to pick up my mail for days at a time since I'll be so busy!

And how on earth can we meaningfully - and economically - provide the same services to people in their homes - spread out all over a city - as we can to those living in close proximity?

Here are two words for today: choice and community. What I will want may be quite different from what you will want. What both of us will need, however, to support us into our elder years, is a community.

Wednesday, August 29, 2007

Words DO Matter - Let's create a new caring language

Russ Hughes from SC made the following insightful comment:

In reading your post regarding efforts to unionize Atria, I was stricken by the impact of language on our culture of care and its implications for how we view what we do. My reference is to the use of the word "front-line" in referring to staff who provide direct care to elders. While innocuous in and of itself, it conjures up images of World War II (as depicted in movies) of forces squared off against one another with a clearly defined "front-line" that places us (the good guys) and them (the bad guys) on opposite sides of that line. When we in the nursing care programs use such a term, it implies that the good guys are the staff and the bad guys are the elders.

Of course there are numerous terms we use that to those outside the industry similarly connote an adversarial relationship between care givers and elders. Too often we hear such of those as "in the trenches," "non-compliant," or "uncooperative" (or numerous others) that suggest we are on opposite sides from those we serve.

As a major source of education, aQuire is in an excellent position to provide leadership in awareness and this culture change effort.
Thank you, Russ Hughes, Ph.D., N.H.A. SC Department of Mental Health

Russ goes on to say,

I would welcome opening the discussion to others including through your blog. Perspectives would be most interesting I would think. I have always wondered at the use of the word "facility." Outside of our "industry" facility tends to conjure up the image of a warehouse and "skilled nursing facility" suggests something very highly technical (skilled). How about "wards" and "units?" Those certainly do not connote something "homelike" but harkens back to the days of nursing homes as sterile mini-hospitals.

I'm with you, Russ. Let's take this opportunity to work together to craft a language of caring that moves us into the new millennium. I mentioned earlier my conviction that we have the ability to train staff to view care communities (NOT facilities) as true communities: homes of the people who live there, with services provided to them as they WANT and need them, not just as we see fit.

In our company we are indeed privileged to be training the next generation of senior care providers. I'm very excited about the ability to affect the language we use and to teach a new language that more accurately reflects the caregiving model we want - for our parents and ultimately for ourselves - into the future.

Please join the conversation. Whether you're a senior, a family member, a senior care professional or just a future consumer - let us know what you think. We have an opportunity to shape at least a part of the future of care together!

Tuesday, August 28, 2007

Sandwiched Baby Boomer Sticking Together

At least there are a lot of us! Thanks, friends at the blog Nourishing Relationships, for sharing your comments about my blog:

I want to applaud you on your terrific posts about the Sandwich Generation. Your storytelling, blending professional wisdom and personal humor, is charming - a refreshing and informative read for those struggling with the challenges of a family in flux.
I've been googling a few new contacts and read so much negative press about just about every company out there that it feels good to read nice, positive comments!

Here are just a few other comments from recent news items or posts that struck me as interesting:
I was not ready for my energy to be sapped by giving dating advice to both my daughter and my mother at the same time. (By Susan Brooks-Thoman, on the Victoria Habelrih blog).

That comment made me smile - and made me just a little nervous about my own newly widowed mom (and my three unmarried daughters...will this be me someday?)

Tim from Michigan emailed me:

I have searched low and high and have yet to find info specifically for the male caregiver. I guess I'm in a very small minority or maybe it's just that most men won't or can't share their experiences.
While Tim IS in the minority, he's not alone. The Caregiver Resource Center in Kalamazoo, MI, provides a much needed service to all caregivers, young and old, male and female, according to a recent article in the Kalamazoo Gazette. Director Colleen Simpson comments,

...more and more men are taking on the role of caregiver, and teens and preteens caring for the needs of an elderly relative while their parents work are also on the rise.

The center provides education resources as well as support for caregivers.

While there's no doubt more and more of us are assuming caregiving roles, at the same time it is comforting to know that we are not alone. In fact more resources exist now than at any previous time in history to support family caregivers.

So from that perspective, it's a great time to be a sandwiched boomer!

Monday, August 27, 2007

Innovation and Technology Applications in Senior Care

“Mom, lay back down and push your call button. Someone will help you get up. Lay back down now, mom!”

That’s the voice recording my friend Lane put on the fall alert device he recently purchased for his mother. She has been getting increasingly forgetful, and has been experiencing some falls. After a nasty fall last Christmas, Lane found an assisted living community near his home and was delighted to be able to secure a unit for his mom.

No matter how many times Lane and the staff there have instructed her she simply can’t remember to use the call system before getting out of bed. When she attempts this by herself, she falls. So far she has not suffered any injuries, but a few months ago while Lane was traveling out of the country, his mom fell again. To make sure she didn’t have any injuries the assisted living staff sent her to the hospital for a check-up and X-rays. At the hospital, staff became alarmed and determined that she wasn’t appropriate for assisted living – she was too great of a fall risk.

What happened next was a nightmare for Lane’s mom: admission to a skilled nursing center where, to prevent her falling, she was immediately put into a wheelchair and taken to the dining room, pushed up against the table and wheels locked in place.

She was accompanied on walks a couple of times a day, but other than that she was in the wheelchair, unable to get out.

When Lane returned from his trip, he was horrified to discover his mom unhappy, depressed and significantly weaker than when he left. Lane immediately moved her back into the assisted living community and started looking at options to keep her safe – and independently mobile. She uses a walker, and she wants to walk. While she seems to be able to walk relatively safely now, getting out of bed unassisted is her trouble spot.

Lane looked at alarm systems; by the time staff was alerted, however, his mom was out of bed and on the floor.

So he discovered the voice alarm alert. Now, he goes to visit his mom and she’ll say, “It was the strangest thing: I heard your voice in the middle of the night last night telling me to get back into bed!”

So far, mom has had no further falls. For Lane – and more importantly, for his mom – the risk of falling is not the worst thing that can happen. The worst thing, by far, is losing the independence and mobility she has left.

Do you know some innovative devices currently available to promote independence? Share them!

Friday, August 24, 2007

Innovation is the Word of the Day

While many are busy criticizing senior care providers for perceived problems – and certainly, there are companies and communities that do have significant problems – what isn’t getting as much attention is the innovation in services that many providers are implementing. These innovations are designed not only to meet the expressed needs of today’s seniors (mental stimulation, life-long learning are at the top of the list) but also to improve the public’s perception of senior care and improve overall services.

Consider what Atria, subject of many negative news stories (and my last blog) is doing in its Burlington assisted living community, incorporating Nintendo’s Wii video game into community activities:

The Nintendo Wii is not only for the young, but the young at heart," said Zappala [the community’s Executive Director] via e-mail. "Those who participate are not only staying physically active, but mentally active as well. The Wii stimulates their mind by incorporating a significant level of hand and eye coordination.

Then there’s the community in Canada that is actually growing grass on the roof:

Shalom Manor and Shalom Gardens, a linked Dutch-Christian nursing home and assisted-living facility, is going green, with a rooftop revamp. The facility has decided to transform its bland grey asphalt roof into a lush, year-round scenic piece of nature, with more than 3,000 square metres of garden.”

The point is both esthetic (more than half of the resident’s view was of the old, flat roof) as well as environmental. Both management and residents like the idea of doing something that enhances the environment in many respects.

Ecumen is in the news again with a program especially designed to promote senior wellness – both in the residential community and in the community at large. More importantly, staff are also welcome to use the fitness equipment, mingling with residents and guests as they improve their own physical wellbeing.

Vitalize! Wellness Centre, opening this fall , will have all the bells and whistles . . . TechnoGym weights and TechnoGym aerobic fitness equipment that digitally measure one’s personal progress, a warm-water lap pool, a warm water pool with a treadmill, herbal teas and great food, exercise rooms, massage, plus classrooms for lifelong learning that helps people explore, personalize and enhance dimensions of successful aging.
The point of all of this innovation is to keep pace with what seniors are looking for in their aging experience – a chance to keep living vital, involved lives right through the end of their days.

Senior care communities that want to stay in the news in a good way – and more importantly, meet the rapidly changing needs of their target market – should listen, learn and innovate!

Wednesday, August 22, 2007

An Offer to Atria and Assisted Living Communities

Atria is still making news as the target for unionizing efforts by SEIU, who is now focusing on yet another Atria community, this one located Riverdale, NY. SEIU, presenting itself as “Senior-care advocates from the Campaign to Improve Assisted Living”, has been zeroing in on the national company’s 121 facilities in 27 states as a prime target for unionizing caregivers throughout the US.

SEIU has issued press releases on Atria beginning some months ago, with the most recent ones coming in a one-two punch August 19 and 21st. In each press release the union focuses on a community with infractions, and their “advocacy” work on behalf of residents. Here’s a paragraph from the press release dated August 19, 2007:
Advocates will deliver an over-sized "Get- Well" card to residents, and ask to meet with facility administrators to discuss the recent viral outbreak that drove residents to their rooms and closed down the communal dining room.
No mention, of course, that over the past few years viral outbreaks like this have occurred in many communal living/dining environments. Some, including one in the state of Washington, resulted in multiple hospitalizations of residents as well as hospitalization of staff and even some emergency workers responding to the situation (these are nasty bugs indeed). Clearly Atria is not alone in experiencing this admittedly dangerous, distressing situation.

And while I’m all for advocacy, I’m truly for advocacy that supports all the needs of the consumer – in this case the senior and his or her family – both in improving care and in increasing accessibility. Explain to me how putting an organized labor union layer between owners, management and caregiver is going to truly achieve either one. As unions siphon off their dues, someone will pay that cost. And the possibility of a labor strike as a tool to increase wages certainly won’t benefit the residents.

So to John Moore, CEO of Atria Senior Living Group and all the other assisted living communities who are interested in genuinely improving care and services, I have an offer for you. We’ll provide to you – at no charge (other than set-up fee) for up to 6 months – our online staff training system, aQuire Training Solutions, to help you demonstrate your commitment to increasing staff training.

Even the SEIU knows that a better trained workforce is a workforce that will provide better quality care. Here’s their press releases’ closing line:
The Campaign to Improve Assisted Living is calling for Atria to make a real investment in front-line care by staffing-up, increasing worker training, and lowering worker turnover.

Atria – we’ll help you achieve this without unionization. Any other assisted living company – the offer stands for you, too. Contact me and I’ll personally sign you up.

Tuesday, August 21, 2007

Engaging Caregivers' Minds

Today's news is an interesting mix of topics:

  • People traveling to Mexico for more affordable long term care (see past comments on the need for creative, affordable options right here at home);
  • New program and services designed to better support family caregivers:
    Sen. Amy Klobuchar,U.S. Senator from Minnesota has a new proposal:

"Most caregivers report taking time out of the work force, cutting back on hours and turning down promotion opportunities. One recent study found that women who provide care to an aging parent suffer about $8,600 per year in lost wages and benefits.

"Family caregiving also has a significant impact on our economy,costing businesses an estimated $33 billion annually in lost productivity.

"For all of these reasons, I am introducing federal legislation to assist our family caregivers."

I applaud this attention to the needs of the family caregiver – and the effort to do something to support these dedicated individuals.

  • A comment by Carol O’Dell (Mothering Mother, Kunati Press) “Engaging the caregiver’s mind is a challenge” as she goes on to share her experiences of depression, isolation, and the mind-numbing repetition of caregiving tasks. Carol describes her challenge to stay mentally engaged, active and growing as a person, and to fight the apathy that threatens to overwhelm.

    As I read today’s news and comments I am again convinced that, as a profession, we need to do two things: listen – carefully and hard – to family caregivers. Hear what they are saying. They need our services; they WANT our services. We need to listen and support them.

    Secondly, we need to engage the mind of the caregiver. Not just the family caregiver but the professional caregiver as well. Imagine the daily mind-numbing repetition of caring for many individuals, then going home to care for your own family and personal needs. Engaging these individuals’ minds – giving them challenges, new skills and opportunities for personal and professional growth – is one of the greatest gifts we can present to the caregivers we encounter and employ.

Monday, August 20, 2007

Someone to Watch Over ME!

Call us the Sandwich Generation - Baby Boomers - whatever you want. The truth is, we're tired! We're working to put kids through college (one down, 2 to go); we're helping our folks managing their lives, sometimes on a day to day basis. We still have a mortgage, and that private college tuition increase is putting us over the edge.

Last week as our middle daughter was heading back to college (the $40K+ a year expense item) she talked about how nice it was to be able to just run over to the school cafeteria and pick up some hot, home-made food without having to take the time or effort to cook it herself. Even though she'll be living in an off campus apartment, she'll still take advantage of the cafeteria from time to time.

I laughingly told her I was looking forward to moving into a retirement community myself someday and having someone cook for me, too. I like the idea of someone planning social outings and cleaning my home, too, on a regular basis.

While so much attention in the news focuses on people trying to stay out of retirement or assisted living housing, there is certainly a segment of us boomer population who are anxiously looking forward to the days when we can just run to the dining room and pick up a hot, fresh meal – prepared by someone else.

In our community (Portland, Oregon) a new senior high rise on the city waterfront, the Mirabella, being developed by Pacific Retirement Services is already sold out with a waiting list - and it's not scheduled to open until 2010. Some friends of ours have signed up, and they can’t wait to move in. Other friends are signing their parents up for this opportunity to live in a downtown, waterfront location with all the amenities of luxury retirement living. One sales representative recently told me that they were getting questions they’d never gotten from retirement living prospects before – questions like, “Will there be space to store my kayak?”

As I not-so-laughing said to my daughter, at either ends of your life you get someone to cook for you; in the middle, you’re busting your toosh cooking – and everything else – for yourself and your family!

Tuesday, August 14, 2007

AAHSA's Ethical Imperative is an Imperative for us all

Larry Minnix, President and CEO of AAHSA (American Association of Homes and Services for the Aging) sent his regular message out to members today. Minnix is an articulate, passionate advocate for seniors and the non-profit providers who are his constituency within AAHSA. Implicit in his messages of late is the need to fight hard for the profession, to preserve our ability to communicate directly to our frontline workers without going through union reps, and the real possibility that unionization throughout the profession may not only affect affordability for the consumer, but may have consequences throughout our society – it may, ultimately, bring this industry to its knees. (See AAHSA’s website in response, The Long-Term Care Solution.)

Today’s message from Minnix is titled, “Our Ethical Imperative”; in it Minnix addresses the need for non-profit senior care communities to look first and foremost at ethical behavior and interaction with staff – the human resources ethical standards that, unfortunately, some providers have forgotten. Minnix says, “Our ethical imperative is the leadership dynamic of transformation needed in long-term care.”

He goes on to relate two stories: one about an administrator who paid his immigrant work force minimum wage with no benefits, saying, “If they don’t like it, I can replace them immediately.”

The second story is about a community in Boston, Mary Immaculate Health Care, who chose to continue to pay wages to employees even after a flood left them without a facility in which to provide care.

Our ethical responsibility to our frontline staff has long been a passion of mine. Several years ago I was asked to speak at a state conference on the subject of ethics, and prepared a passionate presentation about the need for ethical pay and treatment of the lowest paid employees, who typically provide the most direct resident care.

I was part of a panel of presenters, including one woman who was the marketing director for a large, national company. Her portion of the presentation briefly mentioned ethics needed in the marketing process, and went on to discuss marketing incentive programs, benchmarks, and ways to increase census.

During the question and answer period, not one person commented on my portion of the presentation, some of which was, I thought, fairly controversial (my intention being to create discussion, debate and provoke some thinking in new areas). Hands went up all over the room, asking the marketing director specific questions all relating to how to get more results from marketing and sales staff.

I left the session wondering if I was talking to the wrong group or just a bit ahead of the curve in thinking about issues surrounding ethical treatment of staff. Here are just a few of the thoughts I presented at this conference:

A corporate executive stopping in at a community facility, dressed in a custom-tailored suit and driving a Lexus, communicates to the staff something that goes like this: “If you work hard enough, keep costs within the low, low budget parameters we’ve set, I’ll be able to continue driving my Lexus and taking my luxury vacations – and you’ll keep your minimum wage jobs!”

Wow! How exciting! I work hard, and for that work I get to earn $10 an hour (if I’m lucky; I realize that’s quite a bit above minimum wage), while the average Administrator earns several multiples of this amount and corporate staff earn even more.

And I’m pretty much OK with that as long as management respects me, listens to me and treats me as a valuable person, not just a commodity.

My own early exposure to this world was working as a nurses aide in a skilled nursing home my first year in college. I was hired on the spot, before my interview was even completed, and, while I was willing to work hard, I asked the supervisor if I could please have Friday evenings off at least a couple of times each month. This was the one accommodation I requested.

I stayed at that job for only one term. During that time, I received not one Friday evening off. I was given 10 – 12 residents to feed, bathe and “put to bed” every shift. I received no training, and spent ½ of one shift shadowing another aide. At no time did the person who hired me – the Director of Nursing – ever check in with me to see how my work was going, or to ask if I needed any additional training or tools.

Throughout my own career I have looked back on this personal experience and vowed never to treat any of my own employees in this way, but rather to listen to them, to really hear them and know them as people, and to treat each person in a fair, ethical manner.

Here’s an Ethics Policy I believe every senior care provider should embrace, adopted from Levi-Strauss’ policy:

Honesty: We will not say things that are false. We will never deliberately mislead.

Promise-keeping: We will go to great lengths to keep our commitments. We will not make promises that we cannot keep.

Fairness: We will create and follow a process and achieve outcomes that a reasonable person would call just, evenhanded and nonarbitrary.

Respect for Others: We will be open and direct in our communication, and receptive to influence. We will honor and value the abilities and contributions of others, [especially the lowest paid employees] embracing the responsibility and accountability for our actions in this regard.

Compassion: We will maintain an awareness of the needs of others and act to meet those needs whenever possible. We will act in ways that are consistent with our commitment to social responsibility.

As Minnix concludes: “We have an ethical imperative…It is the key to transformational leadership to change a broken system of inadequate quality, despite the resources thrown at it and the competition for them. Ethical thinking is the foundation for change. And it needs to happen every day, in every community.”

Non-profit or for-profit, if we are going to continue to achieve our mission – and our margin of profitability – in this vital profession of senior care, we cannot afford to evade this imperative.

Friday, August 10, 2007

Let's not make nursing homes and assisted living Home-Like - let's make them home!

Yesterday I attended a presentation designed to promote Avamere Health Services' newest community, an up-scale retirement residence called the Stafford to open next year in Lake Oswego, Oregon.

The presenter, talking about the meals, said that they won't be "restaurant-like" but will be authentic restaurant style dining. He said in an off-the-cuff manner, “People say their places are home-like, or their meals are restaurant-like; we’re not going to be ‘like’ anything; we’re going to be genuine.”

I thought, “What an appropriate concept for senior living!”

Too often we focus on being home-like, when what we really offer is a home environment that is simply different from the home one lived in before. If we truly believe that our communities are our residents’ homes, why are we describing them as “home-like?”

Several years ago I wrote an essay titled “Changing Home” in which I described our challenge in introducing my in-laws to moving from their long-time house into a retirement community (read it at the end of this blog). What I was trying to convince my in-laws was that they were not leaving home, but simply changing home.

Somehow we don’t seem all that convincing when we describe our communities, assisted living or nursing home, as “home-like.” Let’s start calling them our residents’ home, and training staff to think of them in exactly that way. We’re then guests and employees in our residents’ home, rather than them being visitors in our “facility.”

Maybe changing our mindset, and the way we orient our staff to think about residents and the building will help us achieve a true culture change that will genuinely make a difference in the quality of life and the quality of care.

Changing Home
(Essay written in June, 2005)

A few weeks ago I shared with you our family's story of helping BOTH sets of parents choose to move into a retirement community.

We spent weeks scheduling the first retirement community visit - weeks during which the negotiation went like this, "Mom, Dad, I know YOU aren't ready for a retirement center, but you know how much it would help the other set of parents."

And the reply invariably went like this, "You're right, we're not ready yet, but the other set of parents sure is!"

Finally, we got to the retirement center and spend hours - literally - getting through both sets of parents' anxieties and resistances.When we left, all four parents were talking about how nice this would be - "4 or 5 years in the future" (that's a 92- year-old speaking)!

Now, two months later, MY parents have their name on two waiting lists, and are actively cleaning out their very formidable collection of stuff; my husband's parents are still talking about the "where" and the "when."

My mother-in-law keeps bringing up this refrain, "I never thought I'd have to give up my home."

And I've been thinking we've been missing the mark here, both in our conversations with the folks, and in the marketing within our profession. We're not asking people to "give up their home" - we're simply asking them to change their address.

Because ANYWHERE can be home - whether you own, rent, or stay free. HOME is that place where you feel comfortable being just "you."

Where, if you're lucky (Mom, Dad, are you listening?) you're surrounded by people who make you laugh, who give you something to talk about, and who share meals, good times and bad times with you - and who are there to help you when you need help.
Because a house is just a house...but a home is absolutely wherever your heart happens to land.

Wednesday, August 8, 2007

Are You a Learning Leader? Lessons from MetLife

Every day I'm immersed in training issues for senior care providers: writing and editing CEU courses for administrators, discussing new, creative ways to train caregivers, working with our learning partners to develop online courses to reach out to even more care providers, especially those located in rural, remote areas with limited access to big-city training opportunities.

I love the example of MetLife, and the recent article that came to my attention recognizing this company as a "Learning Leader." Doris Fritz, the VP of learning and development, identifies the company's need to go beyond basic training and to address learning as a vehicle for corporate development in a fast-paced, changing business environment (sounds a lot like senior care, doesn't it?).

MetLife chose three main focuses of training:

1) Centralization and systemization to increase efficiencies;
2) Using technology and a design team to gather resources into the central distribution source;
3) Focusing on learning needs that advanced the company as a whole, including new employee orientation, customer sales and service, and in-depth product knowledge.

MetLife had been offering training as instructor-led, but determined that, to meet their goals, they would need to develop a robust e-learning approach. MetLife chose to hire an in-house team and spent significant resources developing their own e-learning solution.

The result? Quicker and more effective skill building in new employees immediately evident, with anticipation of strong, long-term results from this approach.

The application for senior care is clear:

1) Focus on building a community or company training approach that goes further than simply compliance;
2) Look to technology to help systematize the approach and delivery (and we don't need to build it from the ground up, with those high costs and time delays);
3) Expect increased skill development, at a quicker time-line, than traditional instructor-led approaches.

Improved training is accessible to almost every senior care community and company. Not going the extra mile to provide all the training, resources and support to our caregivers and other staff is a mistake that we cannot afford to make as we build excellence in service.

Monday, August 6, 2007

Outsourcing to India the answer to caregiving costs?

Imagine my surprise to open the Sunday newspaper and read the story of the man who moved with his parents - a 93 year old dad with Alzheimer's and an 89 year old mom with Parkinson's - to India for care that cost him less than $20 a day!

So here's the solution to those high costs of care: move to India. Seriously, though, it's a sobering story. Actually, it's quite heartwarming to read about their 1:1 nursing services, daily massages, and hour long physical therapy sessions. The parents are able to live at "home" - a house they share with their son and round-the-clock care staff.

And it's all affordable, with money left over. Their monthly bill for rent, utilities, food, medications AND 24 hour staffing is less than $2,000 a month. That's compared to the typical cost of about $4,000 a month for each of them.

The son in the story looks at his monthly bill and feels happy with the decision he has made, as now his parents get the care and services they need and can afford easily from their own income.

It's sobering to me to wonder if this is what we've come to as a country: the need to move to India - or Mexico - or Canada - to be able to afford medication and care that we will increasing need as we, and our parents, age.

Are there better solutions? Will we be a part in creating them - or just responding as people like us seek and find their own solutions?