The assisted-living industry has become overbuilt in the Spokane area, spurring stiffer competition and even making Medicaid-covered residents more attractive fincancially, facility administrators here say.


Meanwhile, more assisted-living units apparently are on the way. A 30-bed expansion is set to break ground any day at Guardian Angel Homes in Liberty Lake, and a 24-bed expansion is being weighed at Fairwood Retirement Village, in the Mead area. Operators at those facilities assert that their investments will pay off by capitalizing on niche services.


Although 64 different assisted-living businesses advertise in the Yellow Pages in Spokane County, only 25 are contracted with the Washington state Department of Social and Health Services to provide care under Medicaid, says Shirley Steiner, DSHS regional administrator for resident care services.


Brighton Court, located near Valley Hospital & Medical Center, in Spokane Valley, has been in the assisted-living business for 17 years, the last 11 under the administration of Sandy Davidson, who paints a gloomy picture.


Ive never seen our industry as overbuilt as it is now, he says. The census rates in town are lower than Ive seen. I dont know anybody thats full. The competition is phenomenal.


Brighton Court has 51 assisted-living apartments and is licensed to accommodate 57 assisted-living residents. Davidson says the facility currently has four vacancies.


Meanwhile, says Sam Knutson, manager at Fairwood Retirement Village, in Mead, Medicaid is returning less and less money and adding new regulations. Fairwood routinely transitions residents, when theyre ready, into its assisted-living units, and is planning to construct more such units.


Orchard Crest, in Spokane Valley, has opened three adult-care facilities since 2000, including a 39-unit assisted-living facility in 2002. Administrator Norm Lunt says, Theres too much assisted living in the market, and offers as indisputable proof his assertion that many providers now are taking in a higher percentage of Medicaid patients, which they have avoided doing previously for financial reasons.


Opinions vary on how long it will be before the baby boomer generation triggers a boost in elder care demand, and Lunt suggests times might get worse in the interim.


His theory is that the stock market crash in 1929 and the Great Depression that followed dropped the U.S. birth rate, and people who were born in that era are moving through assisted-living care now.


Knutson says he listens when Microsoft Corp. billionaire Bill Gates predicts there will be a health-care crisis by the year 2010.


We are overbuilt now, but by 2010 it will be just the opposite, Knutson says. Almost all of Fairwood Retirement Villages 142 living units are filled, and it has a waiting list to get in. That makes a pending decision to build 24 more assisted-living units, to go with the 16 Fairwood already has, look to be a natural on paper, and that decision probably will be made within the next 30 days, says Knutson.


Like Davidson, others agree that theres a challenge in the assisted-living market.


Some providers have struggled for the last few months, and it could just be the light winter, says Joan Sesdudillo, administrator at Guardian Angel Homes, of Liberty Lake. Maybe the urgency just isnt there. Family members tend to move elderly residents into care centers in the winter when the likelihood that they might fall and injure themselves is high and snow might need to be shoveled, she says.


Hayden, Idaho-based Guardian Angel, which has facilities in Post Falls, Lewiston, Idaho, and Richland, Wash., as well as Liberty Lake, plans to add a fifth building at Liberty Lake to house 30 assisted-living units by this fall, says Sesdudillo. That will give it 30 assisted-living units, 30 enhanced resident-care units, and 30 Alzheimers-dementia units, she says.


The new building will be the only assisted-living operation in Liberty Lake and will offer a higher level of care than most assisted-living facilities, Sesdudillo says. She claims the ratio of staff to residents will be higher.


Facility administrators here say state reimbursements for residents covered by Medicaid dont cover the costs incurred to care for those individuals, causing facilities to lose money. Most facilities prefer to maintain a higher ratio of private-pay residents.


Davidson says Brighton budgets for having just 10 percent Medicaid residents, but currently is well above that percentage.


Some assisted-living facilities specialize in providing for a higher percentage of Medicaid patients. Lunt says those are normally older, more established businesses that have significantly lower property costs. He says that mortgage payments alone often can amount to one-third of a newer facilitys total expenses.


Bethany Place Inc., in Millwood, is a Christian-based resident-care facility that has been providing basically the same assisted-living services since it was built in 1919, long before the term assisted living came into vogue, says Bernadine Wilson, its administrator. She says about 50 percent of its 27 residents are covered by Medicaid.


Services provided


Although assisted-living providers vary in the niche services they offer, such as accepting pets, allowing smoking, or providing extended nursing services for a diabetic, many amenities are standard.


Most residents, especially in newer units, have their own apartment, which averages about 500 square feet of floor space. Residents usually have their own possessions and furniture. Most units are equipped with a kitchenette and a bathroom, says Davidson.


To qualify for a state Medicaid contract, a unit can be a minimum of 180 square feet in size, not counting bathroom space, and must include a bathroom, a microwave oven, a refrigerator, a kitchenette with oven or stove top, counter space, and wiring for a telephone, says Steiner.


Assisted-living residents are routinely provided with three meals a day in a common dining area, snacks when they want them, help with medications, on-staff access to health services, transportation to and from doctors appointments, common areas for socializing, housekeeping services, and access to physical activities and social events. Those who require more care are also bathed, dressed, and have meals delivered to their units.


Within their units, residents normally have emergency pull cords, and sometimes phones as well, to signal staff if they require assistance.


Once they are in their home, we dont bother them, says Charlene Steindorf, assistant director of Emilie Court, a 60-unit Catholic facility located near Sacred Heart Medical Center that, like Sacred Heart, is owned by Providence Health Care.


Assisted living differs from what used to be called nursing homes and now are referred to as skilled-nursing facilities in the acuity of care that is provided. Still, that difference is becoming more of a gray area as assisted-living facilities look to provide continuing care as residents age, and nursing homes close due to financial struggles.


What the future holds


Private-pay charges for assisted living often are determined on a base rate for the room, meals, and basic services, plus additional charges for the level of care required for the individual resident depending on their needs.


The average base rate for Spokane assisted-living facilities, according to a recent MetLife Market Survey of Assisted Living Costs, was $2,575 per month. The national average in that survey was $2,379 per month, including room, board, housekeeping, and personal care assistance.


Davidson was surprised that Spokanes base rate exceeds the national average, but suggests that a large number of rural facilities elsewhere with lower base rates could be a factor.


Both Knutson and Davidson think future assisted-living facilities will be markedly different than those operating today. Although Davidson doesnt expect an influx of baby boomers in the assisted-living market for 10 to 15 years, he thinks their retirement needs will reflect another era.


The next generation of assisted living will be different, he says. Baby boomers will be wanting their lattes, wireless service, computers, garages for the BMWs they no longer can drive, and Bose stereos.