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SARAJANE EISEN: Well, thank you all. This is my first time to Ithaca, to Cornell. So I'm a deep-in-the-south Texan, so it's really a pleasure to be here, and thank you for the warm weather. I think I was allowed to choose a date, and chose the one that is deep into the spring as possible, so y'all honored me with nice weather.
Anyway, as [? Mordell ?] said, my background is very multi-disciplinary. And the question is always, how did you get to where you got? And so what we're going to talk today is about a variety of issues that impact aging in place, talking about the baby boomers, which you all think you'll never be there, but we're here. The three of us are already there. And it's amazing how the years go by.
And so how are we going to take care and design for these very energetic-- in fact, [? Mordell ?] and I were just talking about that. We're talking about at our age, a lot of people are retiring. We're going, what would we do? And this is more the mentality of baby boomers than ever.
So basically, who am I? I'm going to give you a little background on me. I have had a very serendipitous journey to where I started. First, I'm an interior designer. That was my passion from the time I was 14. I knew I wanted to be a designer. So I went to the University of Texas, got a degree in design, then got a masters when I went back to my hometown.
And then somehow, they thought that I might be a good educator. So they asked me to take over the design program. And I had a master's. And I went, sure. Well, three years later, they go, oh, by the way, you need a PhD. And of course, I had two children that were preteens, an elderly father, a husband, and a full-time job. And miraculously, [? Mordell ?] and Roger [? Orwick ?] made it possible for me to come to A&M. So I went to A&M. I commuted three hours each way for five years twice a week. And it was actually the most magical experience, like [? Mordell ?] would say, life changing.
And I did research in healing environments. And my study for my dissertation was on pediatrics and the healing effects of art and art preferences. And that's where I started. And then after I left academia, it was like, OK, now what am I going to do with the rest of my life? There's always another level of learning and you never ever quit learning. As I say, we're lifetime learners. And it's exciting because you keep growing and developing.
And so my husband had retired from oil and gas environmental management. And he was sitting around on a beach in Florida. And we met, connected, loved Fort Worth. So we decided to look at what business that we could go in together. We looked at what population is not going away? Seniors. What is the largest population? Seniors.
And then we literally just googled because we didn't want to just open up a business randomly and start from scratch. And we looked at the best franchises for seniors, and Visiting Angels was in the top five. And they just happened to have a conference in Austin, Texas. We went to it. We liked them. And we bought a business.
And so everything that I did brought me to that point because between leaving academia and going into our own business, I actually worked for a company called Skyline Art Services, which is one of the largest provider of art in health care, based in Houston, Texas. And I did business development and research. And my last research was on aging in place, and I did CEUs based on that for interior designers and architects. So that kind of gives you kind of the journey.
So basically, think about this yourselves. What I always believed that you've got to have a passion. In fact, I know when I started the PhD, I was talking to Roger [? Orwick, ?] and I was like, why do you think I'm going to be a good researcher? And he said, you have a passion for curiosity. You want to know the whys about everything.
And so as I share this information, if you want to know the whys, ask me because I think that you have to understand why things happen. What are the reasons behind it? And that then gives you a grounding for understanding the greater picture. So having a passion for your chosen field, and I know that's why you all are here because there's so much passion integrated into this program.
Saying yes to unexpected opportunities-- you never know when an opportunity is going to knock on your door. Joseph and I we're talking about that just last night about his career. You never know when someone's going to notice something about you or they're going to say, you know what? I think you would be a good fit for this opportunity. So never hesitate to explore it.
And then knowing that every opportunity is building upon everything that you have learned and experienced in your life. So there is no opportunity, no experience that is for naught. And that can be good, bad, or otherwise. But everything you experience is building who you are and your platform of information and experience.
Believing that anything is possible. Never, ever-- I hate to say it. Never take no for an answer. As I say, I have two children, grown children, millenniums. And we always talk about, if you get the answer no, you say, maybe you didn't understand my question. Let's rephrase this until you get the answer yes or the answer you want to hear. So always look for those opportunities.
And life is a sense of adventure. I mean, I flew up here, didn't know where I was going. I just took it because [? Mordell ?] is such a wonderful person and friend. And I thought, take advantage of this. You never know what you're going to walk away from that you wouldn't have had that opportunity to experience. And then, deep down in our hearts, there's always a drive to make a difference in this world. And you can make a difference if your heart and your passion is there.
So we're going to talk about baby boomers. 10,000 Americans are turning 65 each day. That incredible. And I mean, and this is the largest-- about 33% of our population are baby boomers. And the impact upon our society, our health care is huge. We've been talking about this for about the last, oh, 15 or 20 years. How are we going to support this?
And we were just mentioning about Medicare. Of course, we get cuts in Medicare, and who does Medicare support? No? It's our baby boomers. So it's some serious issues that we need to think about. And how are we going to take care of those baby boomers who have definite ideas about how they want to live their life?
Like in our business, Visiting Angels is a non-medical home care business, where we hire caregivers. And they go into the home and take care of individuals so they can stay in their homes. That means that we do anything from personal care-- bathing, showering, dressing, ambulation, meal prep, med reminders, lighthouse keeping, transportation, laundry, even pet care, but everything so they can stay in their choice of residence.
So if you look at some of these, these are who the baby boomers are. They are individuals who are independent. They know what they want. Baby boomers are probably the most economically solid population that have come through our American demographics in a long time. And they want what they want. They feel like they have worked hard. They deserve this.
And a lot of baby boomers don't stop working at your typical, what we call, retirement age. We have individuals working up into their 80s or 90s. I think about Betty White. So she's 80. Wait, no. She's 90 now, I think. I mean, she's still working, but there's so many examples of that. As long as you're healthy, you can continue on with the lifestyle that you had chosen. It's when people begin to sit down and they don't have that passion for life, that's when you begin to fail other than your health issues.
So how do we define seniors? Basically, they're persons of 65 years or older. And just really for research purposes, they're broken down into young-old, which are ages 65 to 74, and then the old-old, which sounds a little depressing, but 75 to 84, and the oldest would be considered 85 and over. But when we get clients, and they say they're 70, 75, we went, oh, y'all are spring chickens. We don't think of anybody being old unless they're over 90. Isn't that amazing?
We have a client who is 96. And she said, I'm going to make it to 100. And she has a benign brain tumor, but she still ambulates. She was independent, never married, never had children, worked for Delta Airlines all of her career. But because she is vital, she is able to stay in her home with our support. And she's getting to make choices on how she wants to live the rest of her life.
And that's huge. Can you imagine not having a choice, someone forcing you to live in a place or in a way that was not what you wanted? So we need to think about this. That does not contribute to a healthy community, when people are being forced, and they take away the sense of control, and they take away basically their soul.
So the broad age variation between seniors is based a lot on their health issues, their frailty. When we talk about frailty, we're talking about how well they can get around. We just got a call last night for a client for 24/7 care. 58 years old, and she went into the hospital a week ago with pulmonary issues and was on life support for five days-- 58 years old.
And she's going home. Her husband works, and he's clueless on how to take care of her. So we're scrambling to get in caregivers to start taking care of her so she can stay at home because she didn't want to remain in the hospital. So just some of the kind of clients that we deal with.
More than 15% of North America's population is over 65. And we're expected to increase to 40% by the year 2030.
So really, when you think about seniors, the average age is 79. One third live alone. A spouse has passed away. They're divorced. Who's going to take care of them. And this was an interesting conversation we had last night with some of the students because we had someone with African origins, China, India, and then American. The difference in comparison to these different cultures of how multi-generations take care of each other.
Our society has become so mobile, we don't have that type of support system like we used to. How many of you all grew up close to your grandparents? Wonderful. That's about maybe a third of the room, I think. I had that opportunity too, and very close. In fact, I went back from college and lived five blocks from my parents, and my children knew their grandparents. That doesn't happen a lot now. We're just so mobile, and everybody's moving around for jobs, so who's going to take care of those individuals?
They typically take six different kinds of medicines. They have 10 different medical conditions. And they could be minor conditions or major conditions. And some degree of dementia-- 95% of all of our clients have some level of dementia. And dementia could be anything from just short-term memory loss, or it could be we have a couple of clients with early onset Alzheimer's that were diagnosed in their early 60s.
So the typical characteristics of seniors-- today, those that are 70 years old are better educated. They've had long careers. They typically have more money than their predecessors. And they expect to be physically and intellectually stimulated. They exercise more. They're involved.
When you look at where people choose to retire, many people choose retire around universities because they had the amenities that they can take classes. They can go to cultural events. So they're looking for continued stimulation.
They have quality and service and delivery expectations that no generation has had before. You just look at the development and the involvement of the design in health care. How many people in the hospital recently? What did you see when you were in that hospital design wise? Was it sterile? White walls? Yes? No? Y'all need to talk. Come on. Tell me what you saw. OK, you. No, you.
AUDIENCE: Yeah, it was just a late night ER visit with one of our [INAUDIBLE], so it was the ER, so not--
SARAJANE EISEN: Yeah, fairly sterile.
AUDIENCE: Yeah, fairly sterile, fairly amenable.
SARAJANE EISEN: How was your customer service?
AUDIENCE: Oh, it was really good.
SARAJANE EISEN: Did you get a follow-up call?
AUDIENCE: Yes. Yeah, the pediatrician followed up the next day.
SARAJANE EISEN: Why do you think they're following up?
AUDIENCE: Just [INAUDIBLE], making sure [INAUDIBLE] that we have a favorable experience and that we go back, rate them higher, [INAUDIBLE] get a survey at some point.
SARAJANE EISEN: Exactly. Yeah. They're making sure there's a follow up, because they don't want you readmitted under 30 days. I know my husband had some oral surgery, and he got flowers the next day. And he was totally shocked that he was getting flowers from his oral surgeon. But he does that. It's good customer service.
And this is part of how the hospitality kicks into this, that what we're taking from hospitality and applying it to health care is not only environments that are humanized, and inviting, and warm, where we feel like it's not such a foreign environment when we go in. But this is being driven by the demands of the baby boomers. If they're going to be in the hospital, they want a comfortable place to be. Someone better be attentive to their needs. There's a very high drive to get what they want.
People not only live longer today, they are generally healthier at more advanced ages and they expect to continue to be healthy. I remember when my grandmother was almost 90, and she was just this vital woman. And she said, I still feel like I'm 25. And I look in that mirror, and I say, who's that old lady looking back at me? She goes, I don't even recognize myself. And so this is kind of the mentality that we're looking at.
The number of disabled elders continues to increase due to the large proportion that are surviving to the much older ages today. You think about the Smucker's that you see on TV, people that have made it to 100. We never dreamed that we would live into our 90s and still be healthy and vital.
So 85% of seniors, if they have a choice, they want to age in place. So then the challenge is, how do we design for them? How do we support this through community services, through home health services? How do we give them what they want? And that's the biggest caveat, the biggest challenge.
So what is aging in place? What does it actually mean? It is a physical entity. It is a choice that people make where they want to live. And it's supported by their neighborhood, their community.
Can you imagine you being taken out of your place that you want to live? All your friends, all of your known entities, your walking paths, your animals-- you have to leave your animals at home. You can't take them with you. How does that affect you psychologically? And then how does it affect you with the stress physiologically?
It's a social dimension. It involves relationship with people. As people age, and we were talking about this this morning, it is very hard to start over when you're in your 60s, 70s, 80s. When you're younger, you have all types of social contacts, and means of meeting people, and developing relationships. As you get older, you become more isolated. You don't have the physical ability to get around. A lot of people are not allowed to drive any longer, so their mobility issues and transportation are very limited. So they can't get out and see people like they used to.
The emotional and psychological dimension, which has to do with the sense of belonging in a community, attachment to people's not only their social groups, people they relate to, their beliefs, their ethnicity. What is the symbolic meanings of where they want to age in place? We get into it. It's not just physical needs being met.
We just had a client recently, and the son had moved her forcibly from her lovely home, large home, for practical reasons, economic reasons. But what he didn't think about is where he was going to place her. And she was miserable.
He just found an apartment. It had no real views to nature. It had no greenery. And he didn't put her things there. He moved in just enough so she would have seating in the living room and a bedroom. And she was so miserable. She said, I don't have my things surrounding me. But what we have been able to do to offset that was provide a caregiver to come in there, get her out, take her places, and be her social support. So that's huge as the years go by.
So the term place is not only where the residence is located. It also has to do with the community, like senior facilities where people can go and work out. They can take classes on areas they're interested in. I've done a couple of presentations at a senior facility in our local area, where I did some of my background on architecture and presented information, just lots of learning possibilities there. They also have health fairs, where people can learn more about their needs and the resources for seniors.
Gerontologists specialized in the area of working with seniors. And they find that attachment to place is huge. And when you have any level of dementia, any change is difficult. You cannot process change. You're not as adaptable. And being able to stay in the place that you remember because with dementia, you tend to have your long-term memory, but you've lost your short-term memory, or some level of it.
My best friend of 40 years just passed away at 68 of early onset Alzheimer's, just tragic. But her husband was magnanimous. I've never seen anybody care for anybody like that. She stayed in their home. He had caregivers coming in, 12, 14, 24 hours at the end. And she literally was in her bed in her living room when she took her last breath.
She never had an outburst of frustration or anger or unhappiness, which is unheard of with Alzheimer's. She was happy because she was safe and loved. So this just translates into how can we provide these environments for everyone and give them a place of choice?
The importance of neighborhoods, where people drop in-- you know your neighbor. They come by. They see you. If there's an issue, they're there to support you. Isolation is a huge challenge as people begin to age. So having that social support and that familiarity of neighborhoods is huge.
So the goals for aging in place-- first of all, the seniors prefer to live in their place of choice as long as they can. And it provides them with control, which is huge, control over their lives, where they can make decisions. Relocation entails losing social relationships as well as disrupting their daily routines. I continue to give you examples because it's been such a learning curve for me.
We have a client who is living in a really lovely home, but her husband had passed away. And she began to have signs of dementia. She would try to cook, and she'd burn everything. So anyway, we started in her home with caregivers. Well, then the children felt like she would be safer and better in an assisted living.
Well, she got there, but because she's lost the cognitive processing abilities to remember how to connect to people, she was staying in her little apartment. And they thought, oh, there's so many activities. She'll naturally just gravitate to that. She'd forgotten how. So now, we have caregivers. I mean, they went to no care, and now we're there five days a week. So the caregivers take her out to activities. They take her out to movies. And she is totally engaged.
And kind of an interesting side to this, she actually was acting out inappropriately with the male residents. She reverted back to when she was maybe a teenager. And that was something that they hadn't anticipated. So you also see an effect on the libido. And they have to be safe. But they say there is more sexual activity in senior living facilities. Have you heard that? Because the libido and the self-control is diminished. So it is an interesting group study.
26% of people who are seniors fear living in nursing homes, skilled nursing homes. And we hear that from caregivers coming in that have worked in them. They don't want to work in them. One thing is they are so-- the staff ratio may be 1 to 10, 1 to 15 patients or residents. They can barely get around to get their physical needs met, much less their psychosocial.
And they have no control. You're told when to get up. You're told when to take a shower. You're told when to eat. You're told where you can stay. Other than that, they park you in a wheelchair. And it's not their fault. It's just the nature of the design of how limited financial. So who wants to be put in that position if you have an option?
These can of result, all of these elements and emotional stress-- and we were talking about depression is one of the fastest growing issues in our country right now. It can be mild depression. It can be very acute clinical depression. And when you have no control over your choices in life, you give up hope.
Any of you all had a situation where you had to work with, say, your grandparents taking away the keys to the car? What was the reaction? Like with yours?
AUDIENCE: [INAUDIBLE] moving in the large [INAUDIBLE] grandmother whose husband passed away [INAUDIBLE] tradition like you're talking about [INAUDIBLE] in home for care or to move her out into a facility. And they did that for two weeks. [INAUDIBLE] reasons for [INAUDIBLE] what kind of transition [INAUDIBLE].
SARAJANE EISEN: Had they taken away the keys? Kind of sort of?
AUDIENCE: Functionally, yes.
SARAJANE EISEN: I'll tell you how we did with my father. My mother passed away young at 63. So I took care of my father for 15 years. And he had progressive dementia. And so we knew he had a wreck, so we had to take away the keys. Well, I figured that if the state told him he couldn't drive-- so I told him he had to go take a test. So he had to go take his driving test. Of course, he couldn't pass it. And he was just livid.
But he still didn't want to give up the car. So I finally took away his car. And I get a call from the dealership. And they said, do you know your father ordered another car? Hardheaded German, he was going to get what he wanted. So he's just an indicator of what we deal with all the time. But when you take away-- it's like those keys are their last hold on their pure independence. And it's just symbolic. Even though they have transportation, it's really a symbolic loss.
So the goals for aging in place are, from a policy maker's perspective, it costs more to put people in facilities than it does to keep them home. And it is costly. I say our services are private pay unless they have long-term care insurance since we're non-medical. So it is expensive. And some people have purchased long-term care insurance, which is a policy that is in addition to their regular medical insurance.
But if they can stay at home, it is more economical. And the other thing about it, it keeps them-- if you have someone there managing their meds, making sure they're eating properly, helping with ambulation or showers to keep them from falling, then they can stay in a healthy situation for much longer.
And many aging societies have endorsed policies that support aging in place. We were talking about-- I believe it's in Finland. We were talking about it last night, and how they have so many designs built into their communities, like having elder care and basically day care for young people where they coexist. So the children support the elderly. And then the elderly are inspired by the children.
So thinking outside the box on how can we create a community support for individuals? And there's a lot of cultures that are doing it really well. And we can learn a lot from them in our communities.
Making more walkable communities, where they're more pedestrian. Like the state of Texas is totally vehicular. We have no place that is really designed as a pedestrian area. But if we did, first thing about how we'd be much more healthy as a community. We wouldn't get in our car every time we had to go to the grocery store. But also, it would bring our communities together. We wouldn't be separate with the different age brackets.
So aging in place depends on healthy lives versus frailty. So to some extent on how they're living environments support them will help with that. So when you go in, and this is really goes back to universal design, designing from the very beginning environments that can support aging in place, having full 32-inch clearance in doorways, so 36-inch doors. There's a trend to have 24-inch doors to bathrooms. Well, what's the one place you've got to get into? It's the bathroom. Having one level, not having raised floors, having seamless thresholds, having open concepts for aging in place.
And I love this one theory. I think it's incredible. And things we just don't think about, they're so intuitive. Lawton did some research in the early '80s and he came up with looking at the proper design of physical environments. And as people age, their environment becomes much more important to them. The environment has to adopt to them and support them versus them adopting to their environment.
And so he came up with the environmental docility hypothesis, and saying that researchers observed that the less competent an individual becomes, the more that their physical environment is important in how it affects them. So how do we design with that concept in place?
It's interesting. As you go into elderly individuals' homes, you find that they have certain characteristics. One is they have a lot of throw rugs around, which causes a lot of tripping issues. They tend to have a lot of trinkets everywhere. They tend to close their blinds and their draperies. There's not a lot of day lighting. So it's kind of like, think about, why is this happening? What is the thought process behind there? I'll let y'all ponder on that.
So the theory of supportive design has basically two areas of concern. One is the prevention of falls. Once someone falls and breaks a hip, a leg, there is a continuous demise of their health issues. And then reduction in cognitive functioning, so the processing.
I remember as my father aged, he had a very simple microwave. And we would say, to warm your coffee, push 1. He could no more remember to push 1. So how do we compensate for that? How do we make this easier? Is it going to be verbal commands, like an Alexis? How do we compensate to support them? And it's so incredibly important to realize that they need to feel empowered. They don't need to feel diminished.
We were comparing young children, like a 2-year-old to an 82-year-old. They basically had the same needs, and wants, and desires. They want to be independent. They want to be heard. They want to feel like that they can do it themselves.
Anybody had a two-year-old? You know how they get. I mean, they're just they're so cute. But an 82-year-old's the same way. Let me do it by myself. Don't diminish my sense of autonomy.
So dangerous falls, they're the leading cause of accidental deaths with senior population. More than 200,000 elderly fall each year and suffer fractures. And it could something simple, just walking across, and their feet get kind of tangled, and they fall, and they fall the wrong way, and there you go. It's a broken hip.
We had this sweet lady who's originally from Colombia. She's by herself, never married. And she had a massive stroke when she was 18. So her left side is pretty much paralyzed. Then she fell in her home, and she fractured her other shoulder. So she cannot dress herself. And cognitively, she is great. But she can't do anything, and she's so angry. She's so frustrated.
But thank goodness we can go in there, and we can support her, and we can also give her hope. And through that support, she's able to sustain her life in her home with her beloved cat. Those animals are tremendous support.
Falls are the leading cause of accidental death. Can you imagine? A fall is an accidental death. And it's not always just from the fall, but it's the culminating effects. Things can happen once they go into the hospital. And sadly, many infections occur when they go into the hospital, and it wasn't even from the fall.
Do y'all know what is one of the highest-- the greatest number of seniors go into the hospital for? Do you know what condition that might be? UTIs, Urinary Tract Infections. And something that I learned along the way was that UTIs affect-- and they're systemic. It's like having a staph infection for seniors. It affects their cognitive abilities. They look like they just had this accelerated dementia. And it basically poisons their whole system. And I find it interesting that it's really in that population. It's not in younger people so much, but it definitely affects them. So that's another thing is encouraging them to drink water, encouraging them to eat properly.
Falls cost about $7 billion for direct care in health care. And just as many Caucasian women will die as a result of a hip fracture as they will from breast cancer-- pretty powerful numbers.
So to enable aging in place, we've got to look at the environmental factors that affect it. We look at open spaces. We look at being able to access bathroom facilities. We look at grab bars, look at zero-level thresholds, look at raised toilet seats to support that.
We also need community care. We need a support for our seniors. And more and more programs are starting. In fact, friends of ours that were in Larchmont-- is that New York?
AUDIENCE: Yes.
SARAJANE EISEN: OK. Anyway, they have a whole senior system there that works with their seniors, where they voluntarily pick them up, take them to activities, take them to doctor's appointments, transport them, do handy things in their homes, just the little things that you need a handy man for. So there's more and more of this type of support. And so it's important to get that information out to seniors because they don't know what's available to them.
So age-friendly communities-- it is so important for communities to not think about people just because they're a certain age that they're not all there and they don't have the same needs, and the fact that we can support them, and we can create urban design that is conducive to these individuals getting out, staying healthy, walking, having services, having stimulation.
Urban planning-- I'm going to go a little bit faster because we're about out of time. But looking at housing, looking at mass transportation, looking at pedestrian paths, parks, making sure that the environments support all levels of needs. And just designing of where they choose to live, making sure it supports their cognitive, as well as their physical.
And then we use a term in health care, patient-centered design. But that is basically centering on what people need, asking them what they want. Don't assume anything. Ask the people that are going to be using it.
So basically designing for how hospitality informs health care design-- residential warmth, where it is identifiable. Customer service is huge. What will take a person back to their health care facility of choice now that we really have a choice? And that's one of the things we ask people when we do an assessment. Where would you go if you had to go to hospital?
Designing for particular cultures, where they feel that they can relate to the design details. Reduce environmental stressors and ease of way finding-- finding your way around. Because way finding poorly designed can cause stress where someone already is compromised.
Lighting is huge with seniors. Your eyes begin to yellow as we age. And so it takes seniors three times-- they need three times more light or illumination than we do in our younger years. It takes them seven minutes to adjust to different light levels, so you can't have a quick change of light. So lighting needs to be uniform and at a higher level.
If they attempt to walk during that time, this could cause falls. So the solution is, particularly at night, have enough nightlights that are placed. Have illuminated switches so they can see when they go to the bathroom, to the living room, to the kitchen.
Color-- using color that is a visual cue of where they're going. Neutral colors are not the most effective. They need to be able to see the differentiation between rooms, between flooring and walls. They don't want to create an illusion due to pattern problems, where they would confuse them and they could fall. A little bit of primary color goes a long way-- a dot of red, a dot of intensity just for interest.
Flooring-- make sure it's non-slippery. Make sure that there is not a glare because it affects their eyes and it could cause confusion. Transition between different types of flooring is close to flush as possible. Do not use mirrors except when totally needed because it can be-- have any of y'all ever walked into a mirror thinking it was another room? So I mean, you can imagine when someone's eyesight is compromised what this would do.
So the boomers have arrived. It is a huge population. So where can you all fit in as a career? What aspect of it can you take and move forward and contribute? So questions?
[APPLAUSE]
AUDIENCE: Does someone want to raise a question from the room? Yes?
AUDIENCE: I guess, because my grandmom, she fell, and it was a downward spiral. Why do you think that is, that after the first one, it was just kind of a downward spiral?
SARAJANE EISEN: Well, the first issue is that when-- say, what did she break a hip, or?
AUDIENCE: I can't remember exactly what it was. Maybe it was [INAUDIBLE].
SARAJANE EISEN: OK. So then what happened? She goes into the hospital, and she lies there because she can't get up and start ambulating immediately, even though they try. And so she loses strength. That's the first thing. And she possibly could pick up an infection there because there are more infections that are acquired in the hospital than they are. Like they say, if you weren't sick before, you're really be sick when you come out.
But really, it's the frailty that occurs then. And because you don't have that resiliency because she probably wasn't real mobile before that. Then it's like, it just compounds the issue is what happens. Typically, you're sent to a rehab, and then there's much more transition now. Then that rehab gets you stronger because they get you up with PT and OT, Physical Therapy and Occupational Therapy, and they get you going.
Then when you go home, they typically send you home with home health, which is also physical therapy. And so it should be that building process. But that's what happens. You just get weaker and weaker, and then you're less motivated. And it hurts too. Unless you're forced, you don't want to get up and work it.
AUDIENCE: When you talk about the cost between a person living in an assisted care facility and living in a home, are you taking into account the cost that it takes to run the home, or is it just the care that's being provided is more expensive in that facility compared to living at home.
SARAJANE EISEN: Good question. It is going to vary. But generally, by the time that people typically are that age, their home, if it's not paid for, the cost is fairly minimal. And so we're talking about somewhat to the extent of, say, if there's a mortgage on it and house insurance. But the food, the utilities is going to be less.
And then you balance it with the cost of going into a facility. It can be minimal $3,000 or $4,000 a month just for that facility, and that didn't include anything else. That's just the basic basic. Some of the real high-end-- it's amazing to me.
I live in Fort Worth. We have a facility. It's real upscale. $500,000 just to buy into it with no equity, just for the right to live there. But they have incredible concierge services and all of that, and they vary. But just to go into those facilities is a minimum of $3,000, $4,000, or $5,000 a month. Does that kind of-- and that's just a generality. It's not a specific. Yes?
AUDIENCE: Well, so do you think that assisted living facilities can provide some sort of direct benefits that with the right resources care at home couldn't?
SARAJANE EISEN: In a facility?
AUDIENCE: Yes, do you think there's some actual direct benefits living facility have that living at home with the proper resources don't have?
SARAJANE EISEN: Yeah. I think that the social activities if a person is able to do that. In fact, there's some wonderful retirement communities. I always think of, what is it, Sun City in Arizona that actually is multigenerational. I mean, they've found that the grandparents, the parents, and then the children when they age because they have so many amenities for retirement.
I think it depends on the cognitive level. And if someone is put there because they can no longer live in their house and it's not a choice-- I don't know. Like I said, with this one woman, if you don't know how to get out there and engage, you're not going to take advantage of it. So I think it depends on the level of cognitive loss and mobility. But I do think they have activities that can certainly be stimulating.
AUDIENCE: [INAUDIBLE] dedicated professionals coming in to do [INAUDIBLE] the care [INAUDIBLE]. There's rumors kind of higher level [INAUDIBLE] compared to previous generations. As a business, [INAUDIBLE] skills?
SARAJANE EISEN: Oh, that is the biggest hurdle ever. We say we can grow our business as we can grow our caregivers. We got this call last night for a referral for this 24/7. And I was like, oh my gosh. I'm calling my staff and going, OK, we got to cover this. Because the balance is, do we have enough caregivers sitting around available? Which we don't typically. And then we had this urgent need.
So finding good caregivers is huge. First of all, it is not a high-paying position. We pay ours as much as we can. But we're still at $11 an hour because we can only charge so much to the client. So there's a balancing. So we typically find people who just have this passion for caring for seniors.
But they have not had the same opportunities as you all. They don't have an education typically. They don't have an economic secure base, and they're kind of hand to mouth. But they typically have wonderful hearts, and that's what we really look for. But it is a huge challenge.
AUDIENCE: Do you think the reason why [INAUDIBLE] pay of the elder population? One, do you see that for high-quality care? Do you see that perhaps in the base allegiance?
SARAJANE EISEN: If we can increase our fees, then we would certainly-- we increase our caregiver rights, our pay rates incrementally. But you're only going to-- you know, we charge anywhere from $20 to $23 an hour. And when you start doing that over an extended period of time, it's expensive. And so people can afford, typically if they're doing extended care.
AUDIENCE: We've run out of time, so let's thank Sara.
[APPLAUSE]
The Cornell Institute for Healthy Futures: Health, Hospitality and Design Industry Seminar HADM/DEA 3033/6055.
