It is curious that two days before the publication of this final article in the three part series, Senior Housing News published a feature article titled Will the Nation Go Broke Paying for Senior Housing & Long-Term Care? in which they carefully layout the impending financial risks that seniors are facing. They also will be digging deeper into the issue and it will be worth watching.
You can read the first two parts of my series here:
Part 1: Is the Nursing Home Industry on the Verge of Collapse
I humbly offer some ideas for solutions.
1. Regulations need to be be person centered.
Unfortunately most regulations are written under the assumption rules are what motivate care givers to treat residents well and by extension, that without regulations, residents will be abused. This is a false assumption. There are care givers who have a heart for seniors and will provide excellent care, because that is what they do. There are care givers who are only motivated by short-term profits and have no regard for the seniors they are responsible for. It doesn’t not matter how big the rule book is, these providers will still abuse seniors. The ideal regulatory environment would: A. Be just narrow enough to shut down bad operators. B. Be flexible enough to be corrective of problems that do occur with good operators. C. Allow significant flexibility to allow new ways of providing care, without having to jump through costly and time consuming regulatory hoops.
2. Initial Licensing and Certification Needs to be less rigid and more streamlined.
This process needs to be designed to allow tremendous flexibly and in terms of both building design and program structure. In addition, while fire and building codes are really important to protect seniors they need to be reasonable. Finally the process needs to be rapid. It should not take two years to get a skilled nursing community through plan check as it does in California.
3. Medical Records Requirements need to be reasonable.
In our current environment, documentation is about three things, maximizing reimbursement, protection from law suits, and staying out of trouble with regulators. Is documentation necessary, you bet, but history has shown that increasing the documentation process has done little to protect residents and has become a major factor in adding costs. As importantly, resident care is now primarily driven by documentation requirements, which means a particular care activity may be done well or may be done badly, and it hardly matters as long as it is done and documented.
4. Significant Resources Need to be Applied to Creating Radically New Solutions.
Some of this is already being to take place. In the last few weeks I have had the opportunity to explore some really amazing ideas with executives at Christian Living Communities, Watermark Senior Living and New Dawn Memory Care. The Greenhouse project is a great example of radical thinking. Here are some other ideas: – Multi-generational communities – Trading of labor by family members in return for reduced fees. – Using Medicaid dollars to pay for assisted living care (this is being done in some areas) – Allowing more flexible staffing models – Allowing more flexible building designs Two areas I would love to see further comment on:
1. What areas do you see that need to be changed?
2. What radical ideas do you have for doing a better more cost effective job?
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Regulations should also include reimbursement incentives for utilizing integrated care models which have been shown to improve health outcomes,enhance quality of life,and reduce costs. These models tend to include physicians,nurses,mental health professionals and care managers who work together to provide coordinated care targeted at the unique needs of each individual. Education for staff,emotional support, interventions targeted at behavioral change and coordination of services are among the services that may be offered through an integrated care team.
From LinkedIn Groups
Steve, thanks for sharing this very insightful article. It is great to see someone like yourself that is so proactive in the industry of Long Term Care. It is needed and we all must do our part to break through the rhetoric and the doom and gloom and put the word act in action. Action is what defines us when it’s all said and done. Steve you are a man of positive action and you prove this each time your name shows up on these discussions. Well done sir.
Posted by Vince Tinto
From LinkedIn Groups
Aging in place will be a partial answer. Building a Video-Village-Network™ will be the second. For more information of the virtual village concept, txt or e-mail me.
Posted by Eric I Mitchell MD MA FACPE CPE
Individuals need to have choice in regards to the care offered to them. Having this choice will assist us in addressing the senior housing crunch we are discussing.
At the moment the decision as to the type of care [housing of an individual] and placement of an individual into a “housing” setting often occurs as a result in the change in health status….often “catching” the individual and/or family unprepared. This places greater demands on our senior housing system.
The choice for the type and services for senior housing needs to be discussed [and preferably the decision made] before the actual care is needed. Planning needs to become part of every individuals lifestyle. For this to happen our licensed health care providers need to take an active role in discussing openly and honestly with the individual and/or the family the health status of the individual and their future health status. To plan appropriately palliative care needs to become an integral part of our health care. Health care providers need to stop portraying a picture that “all individuals will be cured and return to their prior level of functioning”.
Housing options are important to individuals. As a nurse of many years who has worked in different areas of nursing, I rarely have come across an individual who eagerly chooses or plans to enter assisted living, a SNF, or another long-term care facility. An individual’s primary choose [even when they are dying] is to remain at home. The older they are, the more this seems to be their choice.
Aging in place therefore is not only part of the answer but rather I think we should work on making it a primary option for choice. For this to happen, funding needs to be re-routed; families [who are already primary caregivers in most instances] need support including financial, and we need the integrated team of healthcare providers discussed above to make “old-fashioned house calls”.
Caring for individuals who wish to remain in their homes, especially those who require long-term palliative and/or hospice care, is compassionate, respectful, and dignified. In terms of the senior housing crunch, it is also cost-effective and alleviates the “crunch”.
In my opinion, we have a care problem more than a housing problem…seniors are not healhty and as a profession we must Restore them not just house them. Following are excerpts from a White Paper proposals I have to the Governor of Iowa to team up and be the top Blue Zone State.
•We must go to re-enforcement surveys so our body of work will go for outcomes.
•Currently enforcement looks for mistakes and threatens retaliation if the plan of correction is not completed in 10 days and implemented the next 30 days for a revisit…and loss of certification and reimbursement lingers there at all times.
•Threats only get results for a short time. And then are those the right results?
•Re-enforcement and coaching had been found by the great behavioral psychologists to work much better in the long run. The CMS’ 5 star intimidation system is a sham.
•The Re-enforcement survey program called Inspection of Care and QUIP were utilized by the State of Illinois from 1985 to 1992…under Republican administration. Prior to that time Florida had a similar program implemented by Connie Cheren, RN. Pay for Performance reimbursement triggered by the IOC and QUIP were developed by Jerry Rhoads for the State Public Aid Department with great success for the performing facilities and the 6 star winners were the best in long term care…but the worst operators had more political power and killed it in 1992 for market basket updates until case mix came in early in 2000. Which is an averaging method that relegates quality to minimums not maximums. So goes the current money driven health care system.
•Jerry Rhoads has been implementing, as a consultant in 140 SNF’s, the Restorative Model and computerized pay for performance systems with compliant documentation for Medicare beneficiaries since 1987 using CMS revision 262 for compliance standards. This has resulted in 40,000 more patients returning home rather than being institutionalized against their will on Medicaid. He, his wife and son now own two Rstorative Care Centers in Iowa, discharging 55% of the admissions back to their homes.
Posted by Jerry Rhoads
From LinkedIn Groups
Senior Housing is based on, “It can’t happen to us!” Unfortunately the cost of operations continues to grow and the client and their family are seeing their resources drying up at a time when they need it.
Senior Hospitality Owners need to address this as their pool is shrinking and if they as a group do not address this problem, they will be forced to disappear.
The other phrase we hear is, “It cannot happen to us!”. It happens and it continues to happen. Again, owners and managers have to realize that it can and will happen to them! The words, never, can’t, cannot, won’t are words that need to stay in everyone’s vocabulary. Given time it WILL happen. Costs continue to grow and the pool is drying up.
Posted by Kalman (Kal) Kahn
Beware of Greed. Lets get real, costs are high, however, managed properly quality of care does not need to be compromised. In my opinion the level of care in any facility/agency is determined at the level of management and ownership. If you want some insight into how to do this better than I suggest communicating with the lowest paid employees and work your way up.
I still vote for my Periwinkle village concept of affordable adorable, sustainable cottages that can be put up quickly as the need arises. In this community we take care of each other which provides a sense of purpose. When the situation happens and that is no longer possible we hire visiting nurses to work within the community. Hopefully there will be some retired ones who live within the community. Other ideas for higher levels of care but that is where we start. I think I am getting close on this one 🙂
I think this is a great idea. One of my biggest concerns about the current model of luxury senior living is that it sends a subtle but very real message that there is nothing more for the residents to contribute to society, family or friends, and that while comfortable, it is a place where people go to wait to die.