7 Challenges Assisted Living MUST Get Right

Reconciling Contradictions

Assisted Living is a fascinating industry where opportunities abound to improve the lives of the fragile elderly. This unique social setting is where a broadly diverse group of individuals are united by their prerequisite need for assistance with managing their healthcare, and this compels them to make enormous life changes as they embrace a new concept of ‘home.’

A formidable challenge confronting this social model is the need to simultaneously implement 2 opposite and contradictory management approaches:

1.   Synchronized Care, where certain important aspects of daily life must run on a more-or-less fixed schedule - meals, activities, transportation, etc.

2.   Person-centered care, where the unique personal differences that infiltrate every aspect of residents’ lives are not only to be considered but, to the extent possible, accommodated.

The intersection where all necessities converge, however, is healthcare. The need for assistance with managing healthcare is a unifying factor that coerces residents to this setting and distinguishes it from other residential settings. Healthcare is the ‘core’ or ‘essence’ of assisted living, and in order to prevent this model from mutating into a disguised form of a nursing home, and to maintain its identity as a social model of care, there are challenges which MUST be successfully overcome.

Below are 7 Challenges which assisted living MUST get right in order to remain as a viable alternative to nursing homes. These are not the only challenges, but confronting this list head-on should be high priority.

The Challenges

1. INTEGRATED CARE

Declining health is:

·      The leading reason residents come to assisted living.

·      A leading challenge in managing assisted living residents.

·      The leading reason residents leave assisted living.

An Integrated Care model of assisted living recognizes that healthcare must be the core “feature of excellence” that is blended with real estate and hospitality to deliver maximal benefit to its residents.

2. TRANSITIONS

Many people fail to recognize that healthcare is managed in acute care settings (like hospitals) differently than in chronic care settings (like assisted living). The goals of hospitals are short term, standardized treatment of a resident’s illness or episode of care. The forming of nurturing and healing relationships often falls victim to fast paced efficiency in an effort to reduce length of stay and cost of care.

In assisted living, however, just the opposite prevails. The emphasis has evolved from treatment of an illness to recovery from the illness. Since residents are now in their home, relationships and person-centered care are paramount.

These opposite approaches to healthcare management, although necessary in our current healthcare system, are most successfully reconciled by a healthcare (or transitional care) coordinator. This role is key to assuring that residents are connected with the necessary components of healthcare in order to complete their recovery.

3.  ACUITY

Most experienced workers would agree that acuity levels in assisted living are already high and often similar to that of nursing home patients.  But there is no standard definition of acuity or how it might be used in everyday operations. New and practical definitions, albeit imperfect, should be considered.

Accepting the limits of resident acuity that can be competently managed in an individual assisted living community can be a thorny issue. But defining an acuity limit and sticking to it is imperative. The consequences of accepting a resident whose healthcare acuity exceeds the ability of workers to competently manage it endangers existing residents by diverting staff and other resources towards the highest acuity residents, leaving the lower acuity residents with unmet healthcare needs.

An additional concern with accepting high acuity residents is that it invites oversight and regulation from outside agencies. Thus, it is in the interest of assisted living communities to employ the use of a practical measure of acuity at the time residents apply for move-in.

4.    CHRONIC DISEASE MANAGEMENT

Assisted living residents have multiple chronic diseases and a plethora of medications that treat these diseases. The challenge in managing these elderly residents is to maintain all the diseases and medications in equilibrium, in balance with each other

Any disruption in this delicate equilibrium by one disease “acting up” can affect all the other diseases, and the “house of cards” of our residents’ health can come tumbling down into an ER visit, hospitalization, or readmission.

The biggest roadblock to managing assisted living resident healthcare is the physical and communication Gap between the resident and their physician. The traditional doctor-patient relationship becomes disrupted by this Gap and is replaced by awkward and inefficient communication that delays assessment and treatment of changes in condition.

The secret to managing chronic diseases is to close the Gap, and the best remedies are:

1.   Onsite healthcare by attentive physicians and their extenders, and

2.   Healthcare coordinators who facilitate communication.

5. DATA AND ANALYTICS

Healthcare in assisted living often seems like a ‘black box.’ The dearth of actionable and easily understood data means that very few people can clearly and accurately articulate the details of their residents’ and community’s healthcare profiles. Fewer still have no perception of how these characteristics compare with other communities within their own city or assisted living corporation.

Only 3 percent of inpatient long term care providers (mostly nursing homes) report having the capabilities of data-driven analytics to:

·      lower cost of care

·      reduce unnecessary hospital readmissions

·      ensure facilities receive proper reimbursement for the care provided to patients.

Even fewer assisted living communities have this capability.

Thus, there is a monumental need for assisted living communities to develop internal strategies to employ data and analytics to provide optimal care of their residents and to be competitive referral sources for fragile elderly residents.

6. QUALITY MEASURES

Assisted living communities must be able, upon request, to objectively validate the quality healthcare they provide to their residents. Healthcare data must be collected, tracked, analyzed, and communicated to employees and families in order to drive performance improvement.

Examples of important quality measures are: ER transfers, hospitalizations, readmissions, falls, pressure ulcers, behavioral disturbances, pain control, ambulance calls and transfers, resident and employee satisfaction surveys, and many more. Top performance with these important quality measures are a key reflection of healthy and successful assisted living management.

7. FALLS

Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a broken hip or head injury. The average hospital cost for a fall-related injury is approaching $40,000. Additionally, falls are a leading contributor to the liability costs that must then be passed down in the rent paid by all residents.

In nursing homes, 70% of falls occur when patients are alone in their rooms. Data are insufficient to conclude whether this is mirrored in assisted living communities. Nonetheless, a robust and targeted falls reduction program should be in place for every assisted living community.

Dr. Steven Fuller is a physician entrepreneur and Executive Vice President of Clinical Affairs for Doctors Making Housecalls, the largest geriatric medical practice in the southeast United States and specializing in onsite primary healthcare delivery in over 400 assisted living communities.