A hard and sobering look at how hospitals view assisted living, but there is hope that it is changing.

When I attended the Readmission Prevention Summit a couple of weeks ago it was bpth enlightening and discouraging to finally figure out why assisted living communities are having very little success in becoming a part of the readmission penalty solution.  Here is what is happening; Hospitals, ACO’s and Managed Care Organizations fundamentally see assisted living as being exactly the same as a resident living at home.  This is what that means from the acute care point of view:

  • A patient discharged to assisted living needs the same amount of home health and assistance with activities of daily living as does an individual discharged to home
  • The risk of falling is the same in both settings
  • In both cases there is a serious risk of patients not adhering to a medication regimen
  • Access to rehabilitation therapy is limited

All of this means that, when hospitals and physicians make discharge decisions, they assume that, no matter how insignificant any of the above needs or risks are, the patient will be better cared for and safer in a skilled nursing facility.  It also means that the patient/resident experience post-hospitalization is not all that important. The Real Picture In truth there are assisted living communities that operate on a social model and are not good candidates for residents/patients with medical needs, but there are many assisted living communities that have nurses on staff, often 24/7.  These assisted living communities are certainly not replacements for skilled nursing but in many cases they can accept residents directly from the hospital and provide as good or better medical care in a higher quality of life setting and at a lower cost.

Finding a Place at the Table

Here are the initial things you need to do if you want to have a place at the table:

  1. Make a specific list of what your community can and cannot do related to medical and rehabilitation capabilities.
  2. Be in a position to take admissions 24/7, or as close to that as possible.  Be clear and specific as to what the extent and limitations of this are. There are going to be times when a patient is discharged from the hospital or even directly from the emergency room to skilled nursing only because there is no one at home to care for them.
  3. Carefully keep track of your hospital readmission statistics.  This means that every single time you receive a resident from either skilled nursing or acute hospitals you need to keep track of their length of stay, primary diagnosis and, if applicable, reason for readmission.
  4. Once a month, on the same day and time each month, drop off at the hospital administrative offices a one page summary of how you are doing on your admissions.  If you have a great story where you were able to prevent a readmission, write it out and include it on the one page document.

Making Progress

I am particularly passionate about this issue and here is what I am doing and how you can get involved:

  • I have some on-going dialog with some care transition organizations in Southern California. I am working toward taking them on a tour of some Southern California medical model assisted living communities so they can see for themselves what can be done.  If there is a community in your organization that fits that description I would love to hear about it.
  • There will be a national Readmission Prevention Summit on May 7 in Anaheim, California that will include an Assisted Living track that I will be helping to put together.  It represents a great opportunity to be a part of the process.  I will publish the details as they become available.
  • There are a bunch of resources available at the National Readmission Prevention Coalition Website.  Many are free, but there are also some toolkits for purchase.  If you are interested in purchasing any of the resources you can use this discount code SHF2014 for a 10% discount through the month of February.

This represents a tremendous opportunity for Assisted Living. Steve Moran

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