Coming to Grips with ‘ACUITY CREEP’ in Assisted Living

Acuity Creep

"The growing prevalence of assisted living (AL) residents who are older, frailer, and who need more services, more supervision, and more medical attention."

Coming to grips with Acuity Creep is a growing challenge recognized by the majority of AL managers.  This is because the impact of rising acuity pervades AL operations, as it affects staffing requirements, risk for hospitalization, resident turnover, technology needs, cost control, and more.

But incorporating acuity into the thinking and decision-making in assisted living is not straightforward, because the concept can seem somewhat vague, difficult to ‘wrap your head around,’ and impossible to meaningfully quantify.  In addition, a tangible, easy, and practical scoring method has not been available to conscientious AL owners and managers who want to provide the best living environment possible for their residents.  Thus, 45% of McKnight’s survey respondents indicated uncertainty in how to react to acuity creep and are looking for new ways to manage it.  But in order to manage this growing challenge, acuity must first be measured.

From a physician’s perspective, acuity is driven primarily by 2 factors:

• Chronic health conditions
• Prescribed medicines.

A community dwelling senior living independently at home with good health or who has only a few chronic health conditions requiring a couple of prescribed medicines generally has very low acuity.   In contrast, an AL resident who has many chronic health conditions requiring many different prescribed medicines has a very high acuity.  And the medical literature supports the observation that residents with greater acuity are at greater risk for hospitalization which in turn puts the AL at risk for losing a resident.

This understanding now offers an opportunity to develop an Acuity Score whose value is based on the parameters of chronic health conditions and prescribed medicines.  The value of this score is that a single, discreet, specific number (the Acuity Score) can now be calculated for every resident and  will give insight to the scope of health services and amenities residents require.  It can be calculated for new residents to help an AL prepare staffing requirements.  And the average Acuity Score for an AL can be compared to the average score for sister ALs in a corporate portfolio so that regional directors can appreciate the hidden acuity differences between buildings and therefore adjust staffing accordingly.

An example in the use of this method for calculating Acuity Scores for 2 different ALs is shown below in Figure 1.  Each vertical bar is an individual resident, and the numbers above the bars are their calculated Acuity Scores.  The normal Acuity Score for non-institutionalized seniors living independently at home is less than 15.

Figure 1.

There are several important observations to be made about the acuity in these 2 ALs.

• Note the wide variability in Acuity Scores of the residents within each AL. This gives an immediate visual appreciation of the challenges faced when managing the health of seniors with such divergent health needs.
• Acuity Scores can be used to customize resident monitoring, such that an AL may wish to monitor high acuity residents differently and more frequently than low acuity residents.
• The Acuity Score could be used when implementing an acuity-based staffing model. Staffing requirements, including staff training and education, for the AL represented in the top graph (Acuity Score = 62) may be different than the requirements for the AL represented in the bottom graph (Acuity Score = 37).
• The Acuity Score could be used to help determine whether a perspective new resident may be a good fit for a particular AL. For example, an AL with an average Acuity Score of 37 may not wish to accept a new resident whose Acuity Score is 90 because they don’t currently have the staffing to meet the needs of such a resident.

Figure 2 below shows the average Acuity Scores of 10 different ALs.  This visualization gives an immediate appreciation of how ALs differ from one another in resident acuity.

Figure 2.

Conclusion:

The Acuity Score offers a new and novel tool that transforms the somewhat nebulous concept of acuity into a specific number, a value that can be used to bring insight about AL resident health and guide the direction and focus of resident health management.  To learn more about the Acuity Score, please e-mail me at [email protected].

 Dr. Steven Fuller is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing.  This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.  To reach Dr. Fuller, e-mail:  [email protected].