Many assisted living businesses struggle to balance health care with hospitality as they move into a post-pandemic environment.
A cross-section of people with multiple chronic conditions is entering the assisted living sector, making it imperative to strike the right balance. Standardized approaches to care for assisted living residents can strengthen operations, improve the resident’s stay length, and manage comorbidities much longer so that there is no progression.
President of Illumination Analytics, Dr. Steven Fuller, said the opportunity for assisted living providers of all sizes is now.
It is challenging to implement standardized care in assisted living because there are variations in licensure regulations and enforcement policies between states. It appears that executive leadership in some more prominent providers, particularly those that offer assisted living services, prioritizes hospitality above care. This reflects assisted living’s late-inception as a style of hospitality-forward care. This could be changed by adding medical leaders to the C-suite.
There aren’t many successful models.
Some providers have managed to implement successful models of standardized care for residents. This does not imply that everyone receives cookie-cutter care, but instead that there is one integrated program that drives consistent, high-quality care.
Juniper Communities has differentiated itself with its “Connect4Life” integrated care program, which is the attention of all aspects of the company, from marketing and sales to daily care. By 2019, AllyAlign will license Connect4Life for use in participating provider-led Medicare Advantage plans.
As a result of its success, Fuller points to Connect4Life as an example of how a provider can combine care and services, though increasingly, providers are using whole-person approaches to wellness and health.
In addition, Eclipse’s assisted living community takes a standardized approach to patient care, said Sharon Roth Maguire. A gerontological nurse practitioner, she manages the provider’s wellness, care and quality division. Eclipse has over 500 assisted living communities across 25 states.
Maguire became a nurse practitioner at Eclipse in 2020. She developed nurse practitioner protocols, known as pathways that employees may use to establish baseline health profiles and monitor changes in condition.
In addition to holistic approaches to chronic conditions, Revera Living offers a portfolio of 175 facilities worldwide. Its chief medical officer, Dr. Rhonda Collins, says there is a lot of room for innovation. Revera provides residents at its facilities with a holistic approach to wellness, focusing on physical, emotional, social, intellectual, environmental, and spiritual care. This enables them to keep their chronic conditions under control.
This includes chefs, recreation professionals, nurses, and personal support staff working together to assist residents in achieving their health goals.
It was confirmed that more than one-third of seniors suffer from two or more chronic diseases in a 2019 report from the Public Health Agency of Canada. In 2018, 27.2% of U.S. seniors had multiple chronic illnesses, and 39% took five to eight prescriptions daily.
Physicians such as Collins believe that some medications may no longer work for particular elderly residents. They also believe some medications combined cause interaction and side effects that seniors may not articulate. Other medications, such as proton pump inhibitors, are meant to last only for short-term use.
When combined with Revera’s wellness-focused approach, this results in better health outcomes. A baseline health assessment can be conducted in conjunction with primary care physicians and family members.
Partnership opportunities are increasing.
Assistive living communities offer a range of opportunities for providers of all sizes to deliver standardized care.
Dr. Sarah Howd, associate professor of medicine at the University of Rochester Medicine Geriatrics Group, says those opportunities range from partnerships with health systems to expanding home- and community-based services. She is also the medical director of Rochester’s senior living practice.
As a director of clinical services, Howd provides clinical services for various assisted living facilities across the New York region. Each of these buildings is operated by a different company with different expectations around standards of care.
The key is to give staff agencies attention to residents’ daily needs to build a successful care plan. Nurses, care aides, hospitality, and dining staff are all in the community every day. They are the first ones to identify signs of declining health.
It is also easier to coordinate care when clinicians can conduct their exams and work with care aides on site.
For many providers, standardized care plans are imperative as more older persons move to senior housing to manage multiple chronic conditions. According to Howd, the pandemic will open the door to establishing standardized care plans in their communities.
The real estate investment trust Welltower and Anthem’s affiliate CareMore are among those with notable initiatives to make senior living more accessible. Other organizations are also beginning to collaborate with assisted living providers, including Oak Street Health, which provides more integrated care for Medicare Advantage beneficiaries.
Despite this, Fuller says providers’ unwillingness to accept health care becomes increasingly important in assisted living communities is a significant barrier to creating care partnerships.
The dilemma is made all the more complex because clinical executives lack in the C-suites of providers. Those in decision-making positions are unaware of the possibility of health care groups partnering with providers on standardized care plans.
However, there are still those who believe that assisted living is still primarily a product built around hospitality, even though the success of Covid-19 has demonstrated that a balance can be struck between services and clinical needs.
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