Covid-19 dramatically highlighted that senior living communities are health care settings. With that comes an increasing belief among prospective residents and their families that operators will assume primary responsibility coordinating care.
Operators recognizing the shift have been able to create an integrated model, blending the hospitality aspects of senior housing with providing primary care and specialty medical services, in one setting.
These were among the main takeaways from a Wednesday webinar hosted by the National Investment Center for Seniors Housing & Care (NIC) featuring leaders from ALG Senior, Oak Street Health and Eventus Whole Health.
Senior living providers are reaping the benefits of this hybrid model, according to the panelists. Coordinating clinical care in a community provides more positive health outcomes, extends lengths of stay for residents, reduces expenses, can be used as a sales tool to recruit new residents, and puts all stakeholders — operators, primary care providers, clinicians, residents and families — on the same page.
Bringing clinical services in house also generates data that can be used to create efficiencies in care, and alert senior living staff of changes in a resident’s condition.
The foundation is creating an alignment between a senior living provider and a primary care physician, said Dr. Michael Kwame Poku, senior medical director at Oak Street Health (NYSE: OSH). The Chicago-based health system has partnered with operators across the long-term care continuum, including an alignment last year with affordable assisted living company Innovative Health.
Opportunities for partnerships between operators and primary care providers will increase in the future, as acuity creep sets in and more residents need specialty care. They, and their families, will demand it, Poku argued.
A collaborative process
Developing an alignment between a provider and a primary care network is the linchpin to establishing the hybrid care model in senior living, Eventus WholeHealth Chief Medical Officer Dr. Jennifer Rucci said.
The Charlotte, North Carolina-based company developed partnerships across the care continuum, including with ALG Senior.
Rucci noted that acuity creep has increased across the spectrum over the past 20 to 30 years: skilled nursing facilities are now treating residents for afflictions that would have hospitalized them a generation ago; and assisted living facilities are addressing conditions that would have been skilled nursing specialties in years past.
Treating residents in senior living settings gives primary care physicians a bird’s-eye view of their living environments, conditions that can exacerbate their levels of health, and allows them to begin working with facility staff on treatments and building relationships so that they are immediately alerted to changes in condition.
“What I see delivered when primary care services are brought to the patient, and there is alignment with the facility, is incredible,” she said.
From that foundation, specialty care providers can be layered on top, depending on a resident’s need, resulting in better outcomes over a longer period of time, because the alignment is already in place.
“Primary care is the core,” she added.
Because operators have been treating residents with higher acuity needs for years, they cannot lose sight of their role in the alignment, ALG Senior President and CEO Charlie Trefzger said. The Hickory, North Carolina-based operator supports around 160 communities across the Southeast U.S., and a significant portion of its residents have moved in because of a health care need.
The provider’s role in any alignment with a primary care network is essential. The provider’s team members are the ones constantly around residents, interacting with them, providing medications when necessary, and monitoring them for changes in condition. Trefzger stressed that operators must be intuitive and watchful at all times, so that any information regarding changes in condition are conveyed to the clinicians who can make a difference in the health of a resident, and vice versa.
Identifying changes in condition, and providing treatment in a home-based setting, can reduce expenses such as transporting residents to a hospital for care, and is more effective than having a casual physician come through a facility at a set time.
“A hospital is not a safe place to go,” he said.
No data, no trust
Alignments between operators and clinicians can be further strengthened over time as more data is compiled and shared between stakeholders.
As an example, data can be used to track medication orders, who is prescribing medications and determine outliers in prescriptions that are detrimental to a resident’s care and contributing to adverse effects or an increase in falls.
ALG Senior had one resident in its system with 32 prescriptions, at one point, and aggressively went after the physician group prescribing the medications to get the total down to a more reasonable level.
Data transparency can also include incident reports, electronic health records, and other signifiers of a resident’s health, so that the operator and primary care provider can get in front of any burgeoning issues and address them early.
“No data, no trust,” Trefzger said.
Data transparency and sharing will become more paramount, as the industry settles into a post-pandemic landscape. Provider relief and other funds afforded operators by federal and state governments will likely result in stricter oversight.
ALG Senior is already seeing this happen on a federal level with tighter guidance from the Occupational Safety and Health Administration (OSHA), as well as on the state level in several states in which the company operates.
Data transparency and being able to mine the data for discrepancies will be essential in streamlining operations across a portfolio, eliminating variations in compliance with regulations.
“If you have a lot of variation in your network, you’re not going to be able to comply with [regulators’] expectations,” he said.
From a clinical standpoint, reducing variations in care will improve the health outcomes of residents, resulting in a higher census, and will aid marketing efforts for new residents.
“It keeps coming back to that collaboration. If we can work together on all fronts, that’s how we’re going to advance together,” Rucci said.
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