Senior living providers must prepare for “assisted living 2.0,” acuity and care needs rise among prospective residents.
As older adults arrive at senior living communities needing help with chronic conditions, ADLs and medication, operators are pressured to adapt to a rapidly changing part of the continuum, according to SelfHelp Home CEO and Executive Director Mark Dubovick.
As nursing homes continue to close around the country, some senior care organizations are expanding assisted living services to meet the demand for high acuity care for older adults.
Dubovick believes that assisted living is evolving into an “intermediate care facility” with staffing needs that place a greater burden on operators.
“You can provide staff training and the technologies to move forward, almost into that intermediate care model,” Dubovick said during a panel at the RETHINK event in Chicago. “Some communities are able to do certain things under a different license.”
But all of this hinges on educating lawmakers and regulatory agencies to understand the new dynamics at play in assisted living settings to “understand that this is the future” for assisted living, he said.
Assisted living has been and will remain a need-based product, and that creates a challenge in and of itself as older adults now want to remain in their homes longer thanks to increased aging in place services, according to EF Senior Care CEO and Partner Mike Nickolaus.
This has shifted how senior living providers view assisted living, Nickolaus said, from a hospitality and social model to one that is “a medical model” with improved care coordination and care capabilities to meet the demands of assisted living residents today.
“On of the uncomfortable things that we deal with is that we sell a product that people don’t want to buy certainly since Covid,” Nickolaus said during a recent RETHINK panel in Chicago, a WTWH Media event. “We don’t see that going away.”
To adapt, operators have shifted care structures and bolstered care billing to reap the rewards of the quality care that they provide, while preparing operations for a more complex care environment driven by acuity changes.
Plymouth, Massachusetts-based EF Senior Care operates a half dozen skilled nursing, assisted living and independent living communities, while also having consulted with over 180 senior living providers to offer operational support, revenue management, technology integration, facilities management, executive recruitment and property ownership through connecting new investors and health care-based real estate.
Assisted living ‘the new skilled nursing’
As acuity continues to force operators to adapt their care capabilities, rising resident acuity has also blurred the lines between assisted living, redefining aspects of care and management, Dubovick said. The Chicago-based nonprofit senior living community offering a full continuum of services, from independent living to respite care.
“Assisted living is the new skilled nursing and to some degree, hospitals are keeping people for much shorter intervals,” Dubovick said during the panel discussion.
This has led to new entrants into senior living to have “more expectations” of assisted living care levels to be on-par with that of skilled nursing capabilities.
These changes in customer demographics, driven by higher acuity, is “important context” for senior living providers as they look to improve their operations.
As nursing home providers well know, a resident population with more needs can lead to new regulations from states and the federal government. That has shifted the operating environment for senior living providers as they expand assisted living options for residents with higher acuity.
For example, Massachusetts last year passed a bill that will allow licensed facilities to provide oxygen management, injections, ointments, drops and home care, along with wound dressing, specimen collection and home-testing capabilities.
While the legislation is still in the rules making process, EF Senior Care’s co-founder served on the commission helping guide the industry on its path ahead. Rulemaking is a process for developing and issuing rules related to the legislation in question.
“There’s a reluctance of seniors to take advantage historically of what is available so what we hope to see by the end of the year this really starts to drive which [assisted living providers] move up the chain and those that are going to stay where they are,” Nickolaus said.
SelfHelp Home in Chicago took a similar path when it advised lawmakers on new requirements for communication aids for both assisted living and nursing homes.
To meet this higher acuity demand, the SelfHelp team has expanded therapy teams in place that can be “really proactive” with resident care, Dubovick noted.
“Sometimes having people bring in outside care providers, such as caregivers, can, in conjunction with our staff, do things that our staff can’t do by themselves,” Dubovick said. “If you bring in a care provider to help with these things, like keeping an eye on you overnight, since we may not have the staffing model for that, you can stay longer in your assisted living unit.”
Preparing AL models for higher acuity
An important part of EF Senior Care’s consultation business is an education effort to inform and help assisted living providers in Massachusetts be ready for the increased services that will soon be required in assisted living settings.
“We talked about how many owners aren’t prepared for it and don’t want it, and that being reactive is not going to work well,” Nickolaus said. “It cascades into other issues, such as liabilities, so for us it’s about helping facilities that may be underprepared clinically.”
Dubovick added that the “weight of the future” and the necessity of operators to adapt to higher acuity care models lies in this adaptation to existing resident health trends, and not in the past assisted living model where socialization and programming led the way.
“The weight of the future is people coming in later, people staying at home longer and by the time they’re ready to get into assisted living, they’re in a much more frail state,” Dubovick said.
O adults entering assisted living communities today expect higher staffing ratios to meet their increased care needs. An operator’s ability to staff properly comes down to budget and the layout of the community to provide coverage in all areas, Dubovick added.
This puts assisted living providers in competition with skilled nursing providers for licensed clinical staff, especially nursing talent, making the staffing pool more scarce in a sector already witnessing a lack of needed clinical workers.
This means that operators must have a solid “risk management program” in place once operators start attracting higher acuity residents, which brings into play higher operating expenses and liability concerns, Dubovick said.
A grim example of what can happen at an assisted living community that is under-staffed, Nickolaus said, was the recent fatal fire in Fall River, Massachusetts in which 10 people died due to injuries from the fire between the ages of 61 and 86.
In response, assisted living providers in Massachusetts must report emergency preparedness plans to improve life safety monitoring efforts in assisted living communities in the state.
“You’re going to have to start looking at assisted living as more of a skilled nursing facility,” Nickolaus said.
