Let's Collaborate.

A recent report from CliftonLarsonAllen paints a stark picture for the future of skilled nursing facilities (SNFs), highlighting what stakeholders likely know, which is that operating margins are tighter than ever and there are fundamental shifts in how the flow of referrals reach facility doors.

The good news is that providers can overcome these challenges to a large degree by—as you may have guessed—harnessing big data. “By embracing big data, SNFs can demonstrate their value to referral sources in a meaningful way,” the report says. “And by continuously improving outcomes, SNFs can position themselves to provide clinical services in a sustainable, profitable manner.”

The report, which is the 32nd of its kind published by CLA, is divided into two sections: one includes analyses of SNF financial and operating conditions by region and the other provides cost analyses tables displaying a variety of SNF cost data.

Hospitals Impacting SNF Admissions

According to CLA, hospital behavior is having an impact on SNFs in a negative way. Outpatient is the name of the game now (versus inpatient), resulting in fewer hospitalizations and thus fewer SNF admissions. This is mainly because, in a broad sense, the world of managed care, Medicare Advantage, and value-based care favors a process that gets people in and out of institutional care as quickly as possible, with the home care option seen as optimal.

Within this construct, CLA says this scenario is not necessarily dire for SNFs, if, and only if, long-term and post-acute care operators understand what they are up against. This makes it even more vital, they say, for SNFs to have their clinical, marketing, and data tools in top shape in order to make themselves attractive to an acute-care world where cost management is paramount. As this trend continues for fewer hospitalizations, the result will be that more SNFs face insolvency while at the same time others thrive.

This gap in how SNFs perform will be a feature of the industry for years to come and amounts to a Darwinian outlook where the difference between those facilities doing well and those doing not so well is wider and wider, CLA says.

Occupancy on the Decline

Diving a little deeper into the data points, CLA notes that in addition to the slowing of admissions from referrals there are shorter lengths of stay when people arrive. Case in point: there was a 120 basis point reduction in occupancy rates for SNFs between 2015 and 2016, according to the report. “Reduced occupancy is impacting all regions of the United States, and the overall occupancy median is now at 85 percent,” the report states.

This pressure can only continue with post-acute networks narrowing and solidifying, causing the thrive-or-die variances for SNFs. For instance, CLA says their numbers show the 25th percentile of SNFs experienced a 170 basis point reduction in occupancy, while the 75th percentile only saw a 50 basis point decline in occupancy levels. The Darwin movement is in action, CLA says, with those providers already in the mix of the new referral world seeing less of a hit, while those on the outside experiencing a larger loss of business.

Outcomes, Quality, and Efficiency

Options for providers are few, but the status quo is decidedly not one of those options. There must be a managed effort to gather information showing clinical success, which starts, of course, with positive outcomes for residents and patients.

There is a future for SNFs, CLA stresses, but there is a thin line, or margin if you will, between making it work and failing to keep up with a hyper-competitive marketplace that values results more than ever. Not to overstate the obvious, but “SNFs must demonstrate outcomes, quality metrics, and cost efficiency,” in order rise above in this environment, says the report says.

If you want a focused approach to staying on top of industry data and trends that is facilitated by experts in the senior living field, contact Quantum Age today.

There’s always something interesting on Ziegler’s list of the largest not-for-profit senior living organizations, and this year did not disappoint. Aside from the obvious—which groups are still in the top five and which ones have shifted—there are some takeaways that likely indicate industry bellwethers.

According to the report, there are, among other things, revelations about trends in “home and-community-based services, third-party management, rental Life Plan Communities (LPCs), technology adoption, joint ventures, and future growth plans.” Here are some noteworthy highlights:

• Approximately 54 percent of the providers on the list offer some type of home and community-based services to non-resident.
• In addition, the community care at home model is now offered by more than 14 percent of the providers on the list.
• More than one-third of the providers on the list are engaged in a joint venture that involves a health system or home health company. This number has grown by more than 34 percent since last year’s list was published.
• Related to this is the number of providers that have a formal health care contract with an Accountable Care Organization or a bundled payment agreement: the report notes that just 25 percent of providers on the list in 2013 had such arrangements.
• Perhaps not so shocking, but nonetheless noteworthy, is the fact that 84 percent of organizations on the list use electronic health/medical records.

If you’re really interested in getting into the weeds, the list also includes details about the pace of growth, aggregate growth, and type of growth. Here are some takeaways from these sections of the report:

• 75 percent of the providers on the list plan to expand or reposition an existing community in 2018.
• 30 percent said “maybe” in response to being asked if they would planning to add new communities in 2017 or 2018.
• 32 percent said they do plan to add new communities in 2017 or 2018.

Whatever might interest you, the Ziegler 150 offers more than a list: it is also packed with details about the largest not-for-profit providers that cannot be found anywhere else.

If you want a focused approach to strategizing your growth— facilitated by experts in the senior living field—contact Quantum Age today.

By now you’ve likely heard there is evidence that harboring negative attitudes about aging and older adults is bad for your health. In fact, a 2016 World Values Survey found that 60 percent of its respondents felt that older people are not respected. More than 83,000 people in 57 countries took part in the survey, which assessed attitudes to older people across all age groups. Interestingly (and sadly), the lowest levels of respect were reported in high-income countries.

This is just one of many sources that cite the presence of ageism and prejudice about older adults in our culture. And given that the demographic make-up of most of the world is becoming older and older, the impact of this kind of discrimination is destined to get worse, unless someone takes the lead in an effort to change it.

Which is where we, as aging services professionals, come in. Why should we take the lead? Well, there’s the obvious reason: ageism impacts the health and wellbeing of older adults—which it’s our business to protect.

To that end, a group of aging advocacy organizations, in collaboration with the Frameworks Institute, has created an excellent set of resources aimed at helping “advocates drive a more productive narrative about how to capture the benefits of an increase in the average lifespan.”

The Frameworks Institute set out to answer this question: How can the field of aging help build a better understanding of aging, ageism, and what will it take to create a more age-integrated society? To get the answer, the institute collaborated with a number of national aging organizations to conduct an “empirical investigation into the communications aspect of aging issues.”

Among other things, they conducted a Strategic Frame Analysis®—an investigation that combines theory and methods from different social science disciplines to arrive at reliable, research-based recommendations for reframing a social issue. They sought “expert consensus” from aging researchers, reviewed academic and advocacy literature, and interviewed members of the public and analyzed the transcripts to identify the
“implicit, shared understandings, and assumptions that structured public opinion.”

The toolkit offers the original research, evidence-based insights from it, and a “variety of materials to help you apply it.” The authors of the toolkit advise that while you won’t find ready-to-print “turnkey” handouts, it does include examples and guidelines that “help you work more intentionally and strategically to advance the conversation about older people in the United States.”

The Frameworks Institute research report includes the following four parts:

• Anticipating Public Thinking outlines how Americans mentally model aging and related issues, and it pinpoints where these patterns of thinking are likely to challenge efforts to advance an informed public conversation.
• Communication Traps cautions advocates against reframing strategies that seem plausible but are likely to have unintended consequences.
• Redirections outlines a series of thoroughly tested communications tools and techniques for reframing aging and ageism.
• Moving Forward offers concluding thoughts and a call to action.

The authors come to the conclusion that sharing and telling a common story is part of what it takes for a movement to drive major and meaningful social change.

If you would like a focused approach to taking the lead on reframing aging, facilitated by experts in the field, contact Quantum Age today.

In just a couple of weeks, Quantum Age Collaborative will head to the Aging 2.0 OPTIMIZE conference in San Francisco, where we expect to find some highly innovative individuals, organizations, and companies navigating their way through the opportunities presented by the longevity economy.

I am particularly excited about one individual on the OPTIMIZE agenda, Jennie Bucove, founder and CEO of Furnished Living, a company with a new line of furniture “that addresses the needs of older adults and people with Alzheimer’s disease and other dementias.”

What’s most intriguing about the products is that they seem to be highly person-centered. I was able to catch up with Bucove recently to get some more details about the company, as well as a sneak peek of her talk at Aging 2.0 before she gives it on Thursday, Oct. 13.

Like many entrepreneurs in the senior living space, Bucove spent much of her career climbing the corporate ladder before her father’s health began to decline and he had to move to a long-term care center. “The home was lovely and extremely helpful to my father,” says Bucove, “but when I visited him I noticed that once he sat down in the chair in his room he couldn’t get up out of it.” As a result, Bucove says she often had to help him get up.

In addition, Bucove noticed that her father’s bed was made with a plastic headboard that was not at all conducive to his mobility or safety. “His furniture looked like it belonged in a dorm room,” she says.

After talking with friends who’d had similar experiences with their parents and loved ones in long-term care communities, Bucove realized that there had to be a market for better furniture—furniture that would both optimize elders’ independence and heighten engagement with staff and family members. “It was a light-bulb moment for me,” she says.

Bucove soon began compiling a design team and launched a search for a manufacturer. The process was not an easy one, she says, but she eventually found the right group of people, which included renowned gerontologist Rosemary Bakker.

The next step was to find a place to put the furniture to use. In a serendipitous turn of events, Bucove met Mike Shmerling, founder of Abe’s Garden, a memory care community in Nashville, Tenn. Shmerling’s father had Alzheimer’s disease and had lived in multiple long-term care centers. “He had been kicked out of every facility because of his disease, so Mike decided to create a community on his own,” Bucove explains.

She credits Shmerling’s entrepreneurial spirit for being open to putting her furniture designs in his building.

“So I worked with Mike and his design firm to fine-tune the furniture before putting them into Abe’s Garden,” says Bucove. Since then, she says she has learned that the furniture is helpful in improving residents’ independence, enhancing engagement with visitors, and helping staff avoid injury, among other things.

Of the eight pieces of furniture designed and produced by Furnish Living, the supply cabinet and the night stand sound most promising to me. The supply cabinet has a magnetic cover that holds cloth and magnetic frames for photos. “It’s made so family members can take them down and look at them with their loved ones,” says Bucove. The door on the supply cabinet also has no handles and it uses a magnetic lock system so that staff need carry only one key fob to disengage the lock, when necessary.

The nightstand has a light that illuminates the floor in front of it so the user can see the floor in the middle of the night—thus reducing fall risks—and a dimmer so that it doesn’t keep sleeping residents awake but allows for enough light for a staff member to check in.

The Aging2.0 OPTIMIZE conference, which takes place from Oct. 12 to 14 in San Francisco, brings together senior care executives, tech companies, investors, and entrepreneurs from around the globe to experience the intersection of aging and innovation.

If you are interested in attending, the Aging 2.0 folks are offering a last-minute discount for those who register with this code: A2NETWORK.

I hope to see you there!

Wouldn’t it be great if all long-term and post-acute care providers had an electronic health record (EHR) adoption blueprint that guides them through the process, step by step, to implementation? That’s exactly what LeadingAge’s Center for Aging Services Technology (CAST) has done.

CAST announced very recently that it has updated resources on EHRs to include something called a 7-Stage Adoption Model. Developed by CAST for the following LTPAC entities:

• Adult day care
• Attending physicians
• Assisted living
• Acute rehab facilities
• Home health/home care
• Hospice
• Life plan communities
• Long-term acute care hospitals
• Long-term care rehab facilities
• Skilled nursing facilities
• Intermediate care facilitites
• Intellectual disabilities/developmental disability facilities
• Programs for All-inclusive Care for the Elderly (PACE)

The resources also include an updated EHR Selection Portfolio, an interactive online guide, and a new case study that outlines one provider’s journey through EHR adoption. According to a statement from CAST, previous EHR adoption models focused primarily on inpatient settings like hospitals and nursing homes.

This model, however, is aimed at helping all aging services organization in “choosing an EHR system that fits the needs of the organization, its providers, and its consumers, patients, and clients.”

In my opinion, it’s refreshing to see a tool more reflective of where the industry is headed—a more integrated care model that is more about the patient and the care, not driven by the setting.

According to Majd Alwan, CAST executive director, “the CAST EHR Selection Portfolio’s new 7-Stage Adoption Model was tailored to help long-term care providers not only improve efficiency, but also quality of care for their residents.” He also said that he hopes the model will make it easier for more and more providers to integrate advanced EHR functionalities into their operations, and use them to continuously improve care quality.

The 7-Stage model provides a framework to assess the level of adoption and sophistication of use, as opposed to just the overall rate of adoption, of EHRs in long-term and post-acute care. The model also draws from the HIMSS 7-Stage EMR Adoption Model, PointClickCare’s 7-Stage LTC EHR Adoption Model, and Gutkind-Savage’s 10-Stage International EHR Adoption Model.  

No, this isn’t a post about recent high school graduates—it’s actually about their parents, or more specifically, Americans 40 years and older. I am among that group, and we are, for the most part, unprepared to pay for long-term care (something many of us will need in the second half of our lives), uninformed about how it will or can be paid for, and reluctant to go anywhere else but to our own bedrooms to be cared for if or when we need that care.

How do I know this? Here are some stats: A recent survey of Americans 40 and older further illuminates the problem that most of us are woefully ill equipped for the likely inevitability of needing long-term services and supports (LTSS). The survey found that 77 percent of this cohort would prefer to receive long-term care in their own homes, with far fewer choosing to receive care in a senior living community (11 percent) or a nursing home (4 percent)—no surprise here. Released by the Associated Press-NORC Center for Public Affairs, the survey also asked this same group about their preparations for long-term care, and one-third say they’ve done no planning at all for their own care needs.

Moreover, a majority (64 percent) have little confidence that they will be able to pay for it, and just 13 percent are “very sure” they have long-term care insurance, while 4 out of 10 mistakenly believe that Medicare will pay for their care.

Making matters worse, the cost of long-term care is getting more and more expensive and more and more out of reach for a majority of Americans. The Genworth 2016 Cost of Care Survey found that the price tag for long-term care has risen steadily over the past five years. The average hourly rate for a home health aide is $20, a rate that has risen by only about 1.28 percent in the last five years. Assisted living care, at $3,628 per month on average for 2016, has grown by 2.16 percent in the last five years.

Nursing home care—at $225 per day—has made the largest jump in cost, of 3.12 percent in the last five years. No matter how you look at, the cost of long-term care is high—staggering in some cases--and there is no indication that any of these costs will decline in the coming years.

There is a very cool calculator on the Genworth website that helps you figure out what your future costs of long-term care will be, right down to the closest major city. I decided to find out what the price tag will be for me 15 years from now in my fair city of Cleveland, and the numbers are sobering: In 2031, the average annual cost for a home health aide will be about $72,184; an assisted living community will set me back $74,315; and a private room in a nursing home will be $142,165 per year.

If you’re skeptical about whether or not you will need this type of care one day, here’s another stat: Seventy percent of people who turn age 65 can expect to use some form of long-term care during their lives.

What can be done about it? Back in February, a group known as the Convergence Center for Policy Resolutions released a set of recommendations for long-term care financing reform. The framework was developed over the last three years by a group of policy experts and senior-level decision makers representing a “wide range of interests and ideological views,” known as the Long-Term Care Financing Collaborative. Members of the group include Howard Gleckman of the Urban Institute, Jennie Chin Hansen, immediate-past CEO of the American Geriatrics Society, and Gail Wilensky of Project HOPE. Here are some of their recommendations:

• A universal catastrophic insurance program aimed at providing financial support to those with high levels of care needs over a long period of time.
• Private sector initiatives and public policies that will revitalize the long-term care insurance market to help address non-catastrophic LTSS risk.
• Efforts to encourage retirement savings and develop more efficient and innovative use of home equity to assist middle- and upper-income families finance LTSS needs for those risks that are not covered by catastrophic insurance benefits.
• A modernized Medicaid LTSS safety net for those with limited lifetime incomes who are not able to save for these care needs, as well as for those who deplete their assets paying for medical and long-term care costs, including more flexible public programs that can deliver care in the setting most appropriate to the needs of individuals.
• Stronger support for families and communities that are the bedrock for people receiving care at home.
• Better integration of medical treatment and personal assistance.

Although the group acknowledged that many details are yet to be worked out and many questions remain unanswered regarding LTSS financing, they call for more research and “better support stakeholder agreement and informed policy making.”

Not surprisingly, support for policies to help caregivers face the costs of providing long-term care is widespread. Seventy-two percent of those surveyed for the NORC study said they support state programs to provide paid family leave, 83 percent support tax breaks for caregivers, and 73 percent support a Social Security earnings credit for caregivers taking time out from the workforce to provide care.

Just as the cost of college tuition looms for many of us 40-plus Americans, so too does the specter of shelling out thousounds for long-term care. This cohort needs to be educated about what kind of care they will need as they grow older and the reality of how much it will cost.

As these issues are worked through over the coming months (and years), it is wise to look for opportunities for your organization to inform the conversation. Explore solutions you might offer to meet the needs of a cohort with widely varying levels of need, extremely high expectations … and limited resources.